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General NPI Number Information
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NPI Number | 1477798411
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Entity Type | Organization
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Legal Business Name | THE TMJ CENTER CRANIOFACIAL PAIN SC
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 6405 CENTURY AVE SUITE 202
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City | MIDDLETON
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State | WI
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Zip | 53562-2200
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Country | US
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Telephone | 608-833-0865
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Fax | 608-833-8720
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Provider Business Mailing Address
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Address Line | 6405 CENTURY AVE SUITE 202
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City | MIDDLETON
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State | WI
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Zip | 53562-2200
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Country | US
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Telephone | 608-833-0865
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Fax | 608-833-8720
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL A. INSOLERA
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Credential | DDS
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Telephone | 608-833-0865
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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 |
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License Number State |
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