Provider Demographics
NPI:1114196896
Name:PAGONIS, TOM C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:C
Last Name:PAGONIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3628
Mailing Address - Country:US
Mailing Address - Phone:401-846-5060
Mailing Address - Fax:401-848-9853
Practice Address - Street 1:73 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3628
Practice Address - Country:US
Practice Address - Phone:401-846-5060
Practice Address - Fax:401-848-9853
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist