Provider Demographics
NPI:1851727002
Name:SURBER, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:SURBER
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 1:7891 BROADWAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5556
Mailing Address - Country:US
Mailing Address - Phone:219-769-6691
Mailing Address - Fax:219-756-6050
Practice Address - Street 1:7891 BROADWAY
Practice Address - Street 2:SUITE F
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5556
Practice Address - Country:US
Practice Address - Phone:219-769-6691
Practice Address - Fax:219-756-6050
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120076701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics