Basic Information
| Provider Information | |||||||||
| NPI: | 1003012709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | N84 W15865 APPLETON AVE | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622516980 | ||||||||
| FaxNumber: | 2622516982 | ||||||||
| Practice Location | |||||||||
| Address1: | N84 W15865 APPLETON AVE | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622516980 | ||||||||
| FaxNumber: | 2622516982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3457015 | WI | Y | Dental Providers | Dentist | General Practice |
No ID Information.