Provider Demographics
NPI:1568497121
Name:THOMAS A. WARGUSKA DMD PC
Entity Type:Organization
Organization Name:THOMAS A. WARGUSKA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARGUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-424-2121
Mailing Address - Street 1:25 LOOP RD
Mailing Address - Street 2:P.O. BOX 937
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3658
Mailing Address - Country:US
Mailing Address - Phone:603-424-2121
Mailing Address - Fax:
Practice Address - Street 1:25 LOOP RD
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3658
Practice Address - Country:US
Practice Address - Phone:603-424-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191911Medicaid