Provider Demographics
NPI:1174628622
Name:NOMELAND, THOMAS JASON (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JASON
Last Name:NOMELAND
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 1:412 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5248
Mailing Address - Country:US
Mailing Address - Phone:507-334-7595
Mailing Address - Fax:
Practice Address - Street 1:412 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5248
Practice Address - Country:US
Practice Address - Phone:507-334-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1415467OtherUNITED CONCORDIA