Provider Demographics
NPI:1679688386
Name:KAMINSKI, THOMAS E (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 W MASON ST
Mailing Address - Street 2:STE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2331
Mailing Address - Country:US
Mailing Address - Phone:920-857-3011
Mailing Address - Fax:920-857-3016
Practice Address - Street 1:1780 W MASON ST
Practice Address - Street 2:STE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2331
Practice Address - Country:US
Practice Address - Phone:920-857-3011
Practice Address - Fax:920-857-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5270-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice