Provider Demographics
NPI:1427292481
Name:FIEDLER, THOMAS A (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170766
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-8065
Mailing Address - Country:US
Mailing Address - Phone:414-364-2283
Mailing Address - Fax:
Practice Address - Street 1:4425 N PT WASH RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1082
Practice Address - Country:US
Practice Address - Phone:414-364-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002035-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice