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NPI Code Detail

MEDICARE: DR. THOMAS JOHN NOCKERTS D.D.S.

MEDICARE: DR. THOMAS JOHN NOCKERTS D.D.S.
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
1122300000XDentist2800WI

General Provider Information

NPI Number : 1548384548
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS JOHN NOCKERTS D.D.S.
Provider Business Mailing Address
First Line : 2460 FINGER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-4210
Country : US
Telephone Number : 920-469-8484
Fax Number : 920-469-8486
Provider Business Practice Location Address
First Line : 2460 FINGER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-4210
Country : US
Telephone Number : 920-469-8484
Fax Number : 920-469-8486
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2007
Last Update Date : 07/08/2007

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