Provider Demographics
NPI:1487667796
Name:CAIN, THOMAS K (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:CAIN
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 1:2100 WEST COURT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-8220
Mailing Address - Country:US
Mailing Address - Phone:608-755-0400
Mailing Address - Fax:608-755-0300
Practice Address - Street 1:2100 WEST COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53547-8220
Practice Address - Country:US
Practice Address - Phone:608-755-0400
Practice Address - Fax:608-755-0300
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002110-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33383100Medicaid