Provider Demographics
NPI:1154416063
Name:THOMAS J VOLM DDS SC
Entity type:Organization
Organization Name:THOMAS J VOLM DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-784-2110
Mailing Address - Street 1:15738 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5119
Mailing Address - Country:US
Mailing Address - Phone:262-784-2110
Mailing Address - Fax:262-784-9451
Practice Address - Street 1:15738 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5119
Practice Address - Country:US
Practice Address - Phone:262-784-2110
Practice Address - Fax:262-784-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3336500Medicaid