Provider Demographics
NPI:1710055942
Name:THOMAS D. VANOSDOL,DDS,INC
Entity Type:Organization
Organization Name:THOMAS D. VANOSDOL,DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:VANOSDOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-267-7017
Mailing Address - Street 1:2283 PROVIDENT CT
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3215
Mailing Address - Country:US
Mailing Address - Phone:574-267-7017
Mailing Address - Fax:574-267-4337
Practice Address - Street 1:2283 PROVIDENT CT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3215
Practice Address - Country:US
Practice Address - Phone:574-267-7017
Practice Address - Fax:574-267-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental