Provider Demographics
NPI:1972771418
Name:TOBIN J. STRUPP DDS LLC
Entity type:Organization
Organization Name:TOBIN J. STRUPP DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-783-3311
Mailing Address - Street 1:14335 W CAPITOL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2396
Mailing Address - Country:US
Mailing Address - Phone:262-783-3311
Mailing Address - Fax:262-783-3313
Practice Address - Street 1:14335 W CAPITOL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2396
Practice Address - Country:US
Practice Address - Phone:262-783-3311
Practice Address - Fax:262-783-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3573-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty