MEDICARE: DR. THOMAS A. FIEDLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5002035-015	WI

General Provider Information

NPI Number	:	1427292481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A. FIEDLER DDS

Provider Business Mailing Address
First Line	:	PO BOX 170766
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-8065
Country	:	US
Telephone Number	:	414-364-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 N PT WASH RD
Second Line	:	SUITE # 103
City	:	GLENDALE
State	:	WI
Zip	:	53212-1082
Country	:	US
Telephone Number	:	414-364-2283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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