Provider Demographics
NPI:1114063237
Name:FELLNER, THOMAS G (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:FELLNER
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 1:102 HARDING WAY W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1726
Mailing Address - Country:US
Mailing Address - Phone:419-468-4285
Mailing Address - Fax:419-468-6724
Practice Address - Street 1:102 HARDING WAY W
Practice Address - Street 2:SUITE 102
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1726
Practice Address - Country:US
Practice Address - Phone:419-468-4285
Practice Address - Fax:419-468-6724
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH19109OtherDENTAL LICENSE