Provider Demographics
NPI:1659589927
Name:WOMMACK, JAMES STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:WOMMACK
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 1:8540 GREENWAY BLVD
Mailing Address - Street 2:#103
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4700
Mailing Address - Country:US
Mailing Address - Phone:608-831-1282
Mailing Address - Fax:
Practice Address - Street 1:115 W DOTY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3276
Practice Address - Country:US
Practice Address - Phone:608-266-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5341-015122300000X
MN10437122300000X
TX14145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist