Provider Demographics
NPI:1679866701
Name:THOMAS ORTHODONTICS, SC
Entity Type:Organization
Organization Name:THOMAS ORTHODONTICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:T
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:262-251-6820
Mailing Address - Street 1:N94W17900 APPLETON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-8022
Mailing Address - Country:US
Mailing Address - Phone:262-251-6820
Mailing Address - Fax:262-251-8081
Practice Address - Street 1:N94W17900 APPLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-8022
Practice Address - Country:US
Practice Address - Phone:262-251-6820
Practice Address - Fax:262-251-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6375-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty