Provider Demographics
NPI:1548565799
Name:STAMAS, TOM A (DDS)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:A
Last Name:STAMAS
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 1:1020 OCONOMOWOC PKWY
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4621
Mailing Address - Country:US
Mailing Address - Phone:262-567-8386
Mailing Address - Fax:
Practice Address - Street 1:1020 OCONOMOWOC PKWY
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4621
Practice Address - Country:US
Practice Address - Phone:262-567-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3954-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice