Healthcare Provider Details

I. General information

NPI: 1306893623
Provider Name (Legal Business Name): DR. THOMAS P KUHN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 MONONA DR
MONONA WI
53716-3932
US

IV. Provider business mailing address

6105 MONONA DR
MONONA WI
53716-3932
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:
Title or Position:
Credential:
Phone: