Provider Demographics
NPI:1689689382
Name:THOMAS J. YANIK, DDS PC
Entity Type:Organization
Organization Name:THOMAS J. YANIK, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:YANIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-623-1116
Mailing Address - Street 1:2 CONCORDE WAY
Mailing Address - Street 2:BLDG #1
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-1576
Mailing Address - Country:US
Mailing Address - Phone:860-623-1116
Mailing Address - Fax:860-627-5133
Practice Address - Street 1:2 CONCORDE WAY
Practice Address - Street 2:BLDG #1
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-1576
Practice Address - Country:US
Practice Address - Phone:860-623-1116
Practice Address - Fax:860-627-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty