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General NPI Number Information
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NPI Number | 1679866701
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Entity Type | Organization
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Legal Business Name | THOMAS ORTHODONTICS, SC
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | N94W17900 APPLETON AVE SUITE 100
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-8022
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Country | US
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Telephone | 262-251-6820
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Fax | 262-251-8081
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Provider Business Mailing Address
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Address Line | N94W17900 APPLETON AVE SUITE 100
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-8022
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Country | US
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Telephone | 262-251-6820
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Fax | 262-251-8081
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JESS T THOMAS
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Credential | DDS MS
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Telephone | 262-251-6820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6375-015
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License Number State | WI
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