Active NPI
Todd L Needham, DDS
- Periodontics
- Appleton, WI
National Provider Identifier
1174644298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 1514G
- Practice address
- 2535 Northern Rd
Appleton, WI 54914-8753 - Phone
- (920) 731-3224
- Fax
- (920) 731-2910
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 1514G | WI | Primary |
Addresses
Primary practice location
2535 Northern Rd
Appleton, WI 54914-8753
Mailing address
2535 Northern Rd
Appleton, WI 54914-8753
Phone (920) 731-3224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1514G | WI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174644298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2535 NORTHERN RD",
"city": "APPLETON",
"state": "WI",
"postal_code": "549148753",
"telephone_number": "920-731-3224",
"fax_number": "920-731-2910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2535 NORTHERN RD",
"city": "APPLETON",
"state": "WI",
"postal_code": "549148753",
"telephone_number": "920-731-3224",
"fax_number": "920-731-2910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEEDHAM",
"first_name": "TODD",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WI",
"license": "1514G",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.