Individual provider Active NPI

Thomas J Miller, DDS

  • Dentist
  • Green Bay, WI
National Provider Identifier
1760548614
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4298 Issued in IA
Practice address
2805 Libal St.
Ste. C
Green Bay, WI 54301-2877
Phone
(920) 339-8980
Fax
(920) 339-0133
NPI assigned
Dec 28, 2006
Sex
Male
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
Dentist 122300000X 4298 IA Primary

Addresses

Primary practice location

2805 Libal St.
Ste. C
Green Bay, WI 54301-2877

Mailing address

2805 Libal St.
Ste. C
Green Bay, WI 54301-2877
Phone (920) 339-8980

Other identifiers 1

IdentifierTypeStateIssuer
33708700MedicaidWI

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
I20151130000690 WI Order and Referring Only - DentistPractitioner - Dentist 5991950669

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4298IAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel Fama DDS LLC PastSince May 16, 2022 Accepting new patients
Allouez Family Dental Center SC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760548614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST.",
            "address_2": "STE. C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012877",
            "telephone_number": "920-339-8980",
            "fax_number": "920-339-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST.",
            "address_2": "STE. C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012877",
            "telephone_number": "920-339-8980",
            "fax_number": "920-339-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "4298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33708700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.