Provider Demographics
NPI:1235247826
Name:PIEFER-TOMCZAK, SANDRA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:PIEFER-TOMCZAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:PIEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1415 NORTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2051
Mailing Address - Country:US
Mailing Address - Phone:920-899-4676
Mailing Address - Fax:920-682-7374
Practice Address - Street 1:1415 NORTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2051
Practice Address - Country:US
Practice Address - Phone:920-899-4676
Practice Address - Fax:920-682-7374
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI5419-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33785400Medicaid