Provider Demographics
NPI:1407923733
Name:TODD A THAYER DDS MS PA
Entity Type:Organization
Organization Name:TODD A THAYER DDS MS PA
Other - Org Name:THAYER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-488-5622
Mailing Address - Street 1:1050 LARPEUTEUR AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6556
Mailing Address - Country:US
Mailing Address - Phone:651-488-5622
Mailing Address - Fax:651-489-2856
Practice Address - Street 1:1050 LARPEUTEUR AVENUE WEST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6556
Practice Address - Country:US
Practice Address - Phone:651-488-5622
Practice Address - Fax:651-489-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN105891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty