Active NPI
Thomas Erwin Tadysak, DDS
- General Practice Dentistry
- Hayward, WI
National Provider Identifier
1881806149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5735015
- Practice address
- 10610 Main St
Hayward, WI 54843 - Phone
- (715) 638-3403
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5735015 | WI | Primary |
Addresses
Primary practice location
10610 Main St
Hayward, WI 54843
Mailing address
10634W Cty Rd B
Hayward, WI 54843
Phone (715) 462-9638
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33788500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5735015 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881806149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10634W CTY RD B",
"city": "HAYWARD",
"state": "WI",
"postal_code": "54843",
"telephone_number": "715-462-9638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10610 MAIN ST",
"city": "HAYWARD",
"state": "WI",
"postal_code": "54843",
"telephone_number": "715-638-3403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADYSAK",
"first_name": "THOMAS",
"middle_name": "ERWIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "5735015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33788500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hayward, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.