Provider Demographics
NPI:1578834545
Name:EHRHARDT, THOMAS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:EHRHARDT
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 1:1015 S. BROADWAY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-838-1123
Mailing Address - Fax:701-838-1261
Practice Address - Street 1:1015 S. BROADWAY
Practice Address - Street 2:SUITE 20
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-838-1123
Practice Address - Fax:701-838-1261
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice