Provider Demographics
NPI:1598838625
Name:MORYL, THOMAS A (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:MORYL
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 1:850 PROVIDENT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3250
Mailing Address - Country:US
Mailing Address - Phone:574-269-3621
Mailing Address - Fax:574-269-1436
Practice Address - Street 1:850 PROVIDENT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3250
Practice Address - Country:US
Practice Address - Phone:574-269-3621
Practice Address - Fax:574-269-1436
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006839A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics