Provider Demographics
NPI:1629112875
Name:THOMAS M. SEDLAK, P.A.
Entity Type:Organization
Organization Name:THOMAS M. SEDLAK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SEDLAK
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-344-3448
Mailing Address - Street 1:3288 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3212
Mailing Address - Country:US
Mailing Address - Phone:352-344-3448
Mailing Address - Fax:352-344-8938
Practice Address - Street 1:3288 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3212
Practice Address - Country:US
Practice Address - Phone:352-344-3448
Practice Address - Fax:352-419-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN113631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty