Provider Demographics
NPI:1720250491
Name:TWOHIG, SAMANTHA D (RDH)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:TWOHIG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S MACY ST
Mailing Address - Street 2:HEALTH DEPT
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4241
Mailing Address - Country:US
Mailing Address - Phone:920-929-3085
Mailing Address - Fax:920-929-3102
Practice Address - Street 1:160 S MACY ST
Practice Address - Street 2:HEALTH DEPT
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4241
Practice Address - Country:US
Practice Address - Phone:920-929-3085
Practice Address - Fax:920-929-3102
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6906-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist