Provider Demographics
NPI:1770587230
Name:CHIODO, THOMAS A (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:CHIODO
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 1:348 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3110
Mailing Address - Country:US
Mailing Address - Phone:908-722-0850
Mailing Address - Fax:908-722-0865
Practice Address - Street 1:348 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3110
Practice Address - Country:US
Practice Address - Phone:908-722-0850
Practice Address - Fax:908-722-0865
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI209531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1770781411OtherLLC NPI AESTHETIC OMS
NJ095774Medicare PIN
NJ1770781411OtherLLC NPI AESTHETIC OMS