Provider Demographics
NPI:1104041276
Name:PIERRON, THOMAS G
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:PIERRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 GLENDON LANE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440
Mailing Address - Country:US
Mailing Address - Phone:937-434-3272
Mailing Address - Fax:937-293-9961
Practice Address - Street 1:2033 E STROOP ROAD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-293-6329
Practice Address - Fax:937-293-9961
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-25381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice