Provider Demographics
NPI:1497976773
Name:PFOTENHAUER, THOMAS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:PFOTENHAUER
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 1:524 LUDINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3949
Mailing Address - Country:US
Mailing Address - Phone:906-789-9949
Mailing Address - Fax:
Practice Address - Street 1:524 LUDINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3949
Practice Address - Country:US
Practice Address - Phone:906-789-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist