Provider Demographics
NPI:1265556955
Name:NYKAMP, THOMAS L (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:NYKAMP
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 1:2740 EASTERN AVE SE
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3643
Mailing Address - Country:US
Mailing Address - Phone:616-452-5721
Mailing Address - Fax:616-452-0514
Practice Address - Street 1:2740 EASTERN AVE SE
Practice Address - Street 2:SUITE # 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3643
Practice Address - Country:US
Practice Address - Phone:616-452-5721
Practice Address - Fax:616-452-0514
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0134931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice