Provider Demographics
NPI:1700896974
Name:TOMASSETTI, JAMES J (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:TOMASSETTI
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2310 E EVERGREEN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7404
Mailing Address - Country:US
Mailing Address - Phone:920-738-7600
Mailing Address - Fax:920-738-6690
Practice Address - Street 1:2310 E EVERGREEN DR
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7404
Practice Address - Country:US
Practice Address - Phone:920-738-7600
Practice Address - Fax:920-738-6690
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI56991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33789000Medicaid
WIBT9786786OtherDEA NUMBER