1679866701 NPI number — THOMAS ORTHODONTICS, SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679866701 NPI number — THOMAS ORTHODONTICS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS ORTHODONTICS, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1679866701
Entity Type Code:
Organization
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:
N94W17900 APPLETON AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MENOMONEE FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53051-8022
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:
05/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
JESS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
262-251-6820

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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