Provider Demographics
NPI:1871681841
Name:TAM ANH DOAN, THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TAM ANH DOAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 LINCOLN DR
Mailing Address - Street 2:#102
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-365-4418
Mailing Address - Fax:941-365-2704
Practice Address - Street 1:1999 LINCOLN DR
Practice Address - Street 2:#102
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-9120
Practice Address - Country:US
Practice Address - Phone:941-365-4418
Practice Address - Fax:941-365-2704
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice