Provider Demographics
NPI:1043431810
Name:SODANO, THOMAS PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:SODANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6985 C.R.327
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738-9765
Mailing Address - Country:US
Mailing Address - Phone:260-637-8556
Mailing Address - Fax:
Practice Address - Street 1:14932 LIMA ROAD
Practice Address - Street 2:
Practice Address - City:HUNTERTOWN
Practice Address - State:IN
Practice Address - Zip Code:46748-9275
Practice Address - Country:US
Practice Address - Phone:260-637-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice