Provider Demographics
NPI:1881846772
Name:NESLUND, THOMAS P (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:NESLUND
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 1:13 BROOKWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9575
Mailing Address - Country:US
Mailing Address - Phone:717-258-5455
Mailing Address - Fax:717-258-5456
Practice Address - Street 1:13 BROOKWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9575
Practice Address - Country:US
Practice Address - Phone:717-258-5455
Practice Address - Fax:717-258-5456
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027395-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000784427OtherUNITED CONCORDIA