Provider Demographics
NPI:1780839613
Name:THOMAS NIEDERHELMAN DDS LTD
Entity Type:Organization
Organization Name:THOMAS NIEDERHELMAN DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-236-1700
Mailing Address - Street 1:3264 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2738
Mailing Address - Country:US
Mailing Address - Phone:614-236-1700
Mailing Address - Fax:614-236-1777
Practice Address - Street 1:3264 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2738
Practice Address - Country:US
Practice Address - Phone:614-236-1700
Practice Address - Fax:614-236-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2519153Medicaid