Healthcare Provider Details

I. General information

NPI: 1285540658
Provider Name (Legal Business Name): KAMINSKI DENTAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 SCHEURING RD STE 2
DE PERE WI
54115-9491
US

IV. Provider business mailing address

1839 SCHEURING RD STE 2
DE PERE WI
54115-9491
US

V. Phone/Fax

Practice location:
  • Phone: 920-351-5000
  • Fax: 920-351-5001
Mailing address:
  • Phone: 920-351-5000
  • Fax: 920-351-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: THOMAS KAMINSKI
Title or Position: OWNER
Credential: DMD
Phone: 920-351-5000