Provider Demographics
NPI:1578052387
Name:SARKO, THOMAS GARY
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GARY
Last Name:SARKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E 8TH AVE APT 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3082
Mailing Address - Country:US
Mailing Address - Phone:330-240-2127
Mailing Address - Fax:
Practice Address - Street 1:1575 VERNON ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4091
Practice Address - Country:US
Practice Address - Phone:330-753-7734
Practice Address - Fax:330-753-5888
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist