Provider Demographics
NPI:1417936162
Name:KALSOW, TAMMY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:KALSOW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1107
Mailing Address - Country:US
Mailing Address - Phone:608-274-1911
Mailing Address - Fax:608-274-1858
Practice Address - Street 1:6317 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1107
Practice Address - Country:US
Practice Address - Phone:608-274-1911
Practice Address - Fax:608-274-1858
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4604-016124Q00000X
WI1002071-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist