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General NPI Number Information
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NPI Number | 1235296716
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Entity Type | Organization
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Legal Business Name | DR TOM STATZ DDS SC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1608 OHM AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-835-8311
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Fax | 715-835-8311
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Provider Business Mailing Address
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Address Line | 1608 OHM AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-835-8311
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Fax | 715-835-8311
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Authorized Official
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Title or Position | DENTIST
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Name | THOMAS GILBERT STATZ
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Credential | DDS
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Telephone | 715-835-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5001497015
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License Number State | WI
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