Individual provider Active NPI

Sandra Marie Piefer-Tomczak, DDS

  • General Practice Dentistry
  • Manitowoc, WI
National Provider Identifier
1235247826
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
WI5419-015 Issued in WI
Practice address
1415 North 8TH Street
Manitowoc, WI 54220-2051
Phone
(920) 899-4676
Fax
(920) 682-7374
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X WI5419-015 WI Primary

Addresses

Primary practice location

1415 North 8TH Street
Manitowoc, WI 54220-2051

Mailing address

1415 North 8TH Street
Manitowoc, WI 54220-2051
Phone (920) 899-4676

Other identifiers 1

IdentifierTypeStateIssuer
33785400MedicaidWI

Other names 1

  • Sandra Marie Piefer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150225001769 WI Order and Referring Only - DentistPractitioner - Dentist 7012917412

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
WI5419-015WIMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235247826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 NORTH 8TH STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202051",
            "telephone_number": "920-899-4676",
            "fax_number": "920-682-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 NORTH 8TH STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202051",
            "telephone_number": "920-899-4676",
            "fax_number": "920-682-7374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIEFER-TOMCZAK",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "WI5419-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33785400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "PIEFER",
            "middle_name": "MARIE",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

Verify at the official NPI Registry.