Provider Demographics
NPI:1295091171
Name:KLOSTER, TOM OLAF (DDS)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:OLAF
Last Name:KLOSTER
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 1:2215 VINE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-5862
Mailing Address - Country:US
Mailing Address - Phone:715-386-9119
Mailing Address - Fax:715-386-0303
Practice Address - Street 1:2215 VINE ST STE D
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-5862
Practice Address - Country:US
Practice Address - Phone:715-386-9119
Practice Address - Fax:715-386-0303
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist