1922338565 NPI number — DR. JESS TAYLOR THOMAS DDS, MS

Table of content: DR. JESS TAYLOR THOMAS DDS, MS (NPI 1922338565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922338565 NPI number — DR. JESS TAYLOR THOMAS DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
JESS
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922338565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N94W17900 APPLETON AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-8022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-251-6820
Provider Business Mailing Address Fax Number:
262-251-8081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N84W15994 MENOMONEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMONEE FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53051-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-251-6820
Provider Business Practice Location Address Fax Number:
262-251-8081
Provider Enumeration Date:
01/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  6375-015 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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