Provider Demographics
NPI:1174132591
Name:608 DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:608 DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PAUSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:920-948-9214
Mailing Address - Street 1:1465 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1837
Mailing Address - Country:US
Mailing Address - Phone:608-837-5527
Mailing Address - Fax:
Practice Address - Street 1:1465 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1837
Practice Address - Country:US
Practice Address - Phone:608-837-5527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty