Healthcare Provider Details

I. General information

NPI: 1366538266
Provider Name (Legal Business Name): TOM KRAMKOWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W OKLAHOMA AVE
MILWAUKEE WI
53215-4175
US

IV. Provider business mailing address

8861 RAVENSWOOD CIR
WAUWATOSA WI
53226-4670
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-0365
  • Fax: 414-645-1052
Mailing address:
  • Phone: 520-247-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6196-015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: