Provider Demographics
NPI:1184019762
Name:TSEFFOS, NICHOLAS WILLIAM ALFRED (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WILLIAM ALFRED
Last Name:TSEFFOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 W MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8447
Mailing Address - Country:US
Mailing Address - Phone:920-739-1214
Mailing Address - Fax:920-739-5855
Practice Address - Street 1:1801 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2186
Practice Address - Country:US
Practice Address - Phone:414-288-6790
Practice Address - Fax:414-288-3586
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program