Provider Demographics
NPI:1851486484
Name:BAGGOTT, WILLIAM ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:BAGGOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 S 103 ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:414-543-9911
Mailing Address - Fax:414-543-9911
Practice Address - Street 1:3365 S 103 ST
Practice Address - Street 2:SUITE 220
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-543-9911
Practice Address - Fax:414-543-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33429300Medicaid
WI33429300Medicaid