Provider Demographics
NPI:1184847568
Name:NOMELAND DENTAL LLC
Entity Type:Organization
Organization Name:NOMELAND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAMAS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:NOMELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-334-7595
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1415467OtherUNITED CONCORDIA