Provider Demographics
NPI:1396443040
Name:NASCIMENTO, THIAGO DIAS (DDS)
Entity type:Individual
Prefix:
First Name:THIAGO
Middle Name:DIAS
Last Name:NASCIMENTO
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 1:3475 PLYMOUTH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1539
Mailing Address - Country:US
Mailing Address - Phone:763-577-2484
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD STE 255
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6768
Practice Address - Country:US
Practice Address - Phone:952-892-6222
Practice Address - Fax:952-892-6477
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS196122300000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist