Provider Demographics
NPI:1578957411
Name:TMJ PAIN SOLUTIONS, SC
Entity Type:Organization
Organization Name:TMJ PAIN SOLUTIONS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KARKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:262-232-8777
Mailing Address - Street 1:N14W23833 STONE RIDGE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1157
Mailing Address - Country:US
Mailing Address - Phone:262-232-8777
Mailing Address - Fax:262-232-8786
Practice Address - Street 1:N14W23833 STONE RIDGE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1157
Practice Address - Country:US
Practice Address - Phone:262-232-8777
Practice Address - Fax:262-232-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4550151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty