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Dr. Eddie Kiyoshi Brotkowski, DDS,MD
Oral and Maxillofacial Surgery (Dentist) in Fond Du Lac, Wisconsin
NPI 1003100470

Eddie Kiyoshi Brotkowski is a Oral and Maxillofacial Surgery (Dentist) based in West Peoria, WI and is specialized in Oral and Maxillofacial Surgery. Eddie Kiyoshi Brotkowski practices in Fond Du Lac, WI and has the professional credentials of DDS,MD. The NPI Number for Eddie Kiyoshi Brotkowski is 1003100470 and holds a License No. (Wisconsin).

The current practice location address for Eddie Kiyoshi Brotkowski is 464 S Hickory St Ste A, Fond Du Lac, WI and can be reached out via phone at 920-923-0111 and via fax at 920-923-0366.

Location: 464 S Hickory St Ste A, Fond Du Lac, WI, 61604-5011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1003100470
Provider Name
Eddie Kiyoshi Brotkowski
Credential
DDS,MD
Provider Entity Type
Individual
Gender
Male
Address
464 S Hickory St Ste A, Fond Du Lac, WI, 61604-5011
Phone Number
920-923-0111
Fax Number
920-923-0366
Provider Enumeration Date
06/02/2011
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
464 S Hickory St Ste A
City
Fond Du Lac
State
Wisconsin
Zip
54935-5531
Phone Number
920-923-0111
Fax Number
920-923-0366
person
Provider Business Mailing Address Details
Address
464 S Hickory St Ste A
City
Fond Du Lac
State
Wisconsin
Zip
54935-5531
Phone Number
920-923-0111
Fax Number
920-923-0366
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
1001767 (Wisconsin)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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