Provider Demographics
NPI:1538472600
Name:NACK, THOMAS A JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:NACK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5307
Mailing Address - Country:US
Mailing Address - Phone:602-993-9600
Mailing Address - Fax:602-942-0739
Practice Address - Street 1:4996 S POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3602
Practice Address - Country:US
Practice Address - Phone:480-840-3600
Practice Address - Fax:480-840-3200
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice