Provider Demographics
NPI:1457483711
Name:BROERING, THOMAS KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KARL
Last Name:BROERING
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:PO BOX 179
Mailing Address - Street 2:710 EAST MONROE ST
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869
Mailing Address - Country:US
Mailing Address - Phone:419-629-2188
Mailing Address - Fax:419-925-8000
Practice Address - Street 1:710 EAST MONROE ST
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869
Practice Address - Country:US
Practice Address - Phone:419-629-2188
Practice Address - Fax:419-925-8000
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice