Provider Demographics
NPI:1881617637
Name:VODAK, THOMAS ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:VODAK
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 1:2400 WASHINGTON AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2832
Mailing Address - Country:US
Mailing Address - Phone:530-243-3223
Mailing Address - Fax:530-243-8821
Practice Address - Street 1:2400 WASHINGTON AVE
Practice Address - Street 2:SUITE #310
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2832
Practice Address - Country:US
Practice Address - Phone:530-243-3223
Practice Address - Fax:530-243-8821
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist