Provider Demographics
NPI:1437241783
Name:TOM A STAMAS DDS SC
Entity Type:Organization
Organization Name:TOM A STAMAS DDS SC
Other - Org Name:TRIMMELL & STAMAS DDS SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-567-8386
Mailing Address - Street 1:606 E SUMMIT AVENUE
Mailing Address - Street 2:1020 OCONOMOWOC PARKWAY
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-8386
Mailing Address - Fax:262-567-8388
Practice Address - Street 1:606 E SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:OCONOMONOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:202-567-8386
Practice Address - Fax:262-567-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty