Provider Demographics
NPI:1477798411
Name:THE TMJ CENTER CRANIOFACIAL PAIN SC
Entity Type:Organization
Organization Name:THE TMJ CENTER CRANIOFACIAL PAIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:INSOLERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-833-0865
Mailing Address - Street 1:6405 CENTURY AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2200
Mailing Address - Country:US
Mailing Address - Phone:608-833-0865
Mailing Address - Fax:608-833-8720
Practice Address - Street 1:6405 CENTURY AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2200
Practice Address - Country:US
Practice Address - Phone:608-833-0865
Practice Address - Fax:608-833-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty