Provider Demographics
NPI:1649336579
Name:WUNDER, THOMAS G (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:WUNDER
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 1:106 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH JUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46366-1246
Mailing Address - Country:US
Mailing Address - Phone:574-896-2512
Mailing Address - Fax:574-896-2051
Practice Address - Street 1:106 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:NORTH JUDSON
Practice Address - State:IN
Practice Address - Zip Code:46366-1246
Practice Address - Country:US
Practice Address - Phone:574-896-2512
Practice Address - Fax:574-896-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006753A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice