Provider Demographics
NPI:1568455301
Name:NALE, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:NALE
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 1:80 GARDEN CTR
Mailing Address - Street 2:#224
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7087
Mailing Address - Country:US
Mailing Address - Phone:303-469-5301
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR
Practice Address - Street 2:#224
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7087
Practice Address - Country:US
Practice Address - Phone:303-469-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02002558Medicaid