Healthcare Provider Details

I. General information

NPI: 1215959317
Provider Name (Legal Business Name): MADISON ORTHODONTIC CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 MONONA DRIVE
MONONA WI
53716
US

IV. Provider business mailing address

6105 MONONA DRIVE
MONONA WI
53716
US

V. Phone/Fax

Practice location:
  • Phone: 608-663-8819
  • Fax: 608-661-8257
Mailing address:
  • Phone: 608-663-8819
  • Fax: 608-661-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2478015
License Number StateWI

VIII. Authorized Official

Name: DR. THOMAS P KUHN
Title or Position: OWNER
Credential: DDS, MS
Phone: 608-663-8819