Provider Demographics
NPI:1770506610
Name:VANDENBERGHE, THOMAS MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARK
Last Name:VANDENBERGHE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 W SEGO LILY DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3299
Mailing Address - Country:US
Mailing Address - Phone:801-233-0503
Mailing Address - Fax:801-233-0593
Practice Address - Street 1:45 W SEGO LILY DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3299
Practice Address - Country:US
Practice Address - Phone:801-233-0503
Practice Address - Fax:801-233-0593
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT554671223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics