Provider Demographics
NPI:1659461085
Name:KONNERSMAN, THOMAS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KONNERSMAN
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:OLDENBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47036-0188
Mailing Address - Country:US
Mailing Address - Phone:812-933-0368
Mailing Address - Fax:812-934-2845
Practice Address - Street 1:22131 HAUPT STRASSE
Practice Address - Street 2:
Practice Address - City:OLDENBURG
Practice Address - State:IN
Practice Address - Zip Code:47036-0188
Practice Address - Country:US
Practice Address - Phone:812-933-0368
Practice Address - Fax:812-934-2845
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007760A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist