Provider Demographics
NPI:1982901997
Name:VANDYKE, THOMAS ELLIOTT (PHD, DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ELLIOTT
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FIRST ST
Mailing Address - Street 2:SUITE 1756
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1200
Mailing Address - Country:US
Mailing Address - Phone:617-892-8503
Mailing Address - Fax:617-262-4021
Practice Address - Street 1:245 FIRST ST
Practice Address - Street 2:SUITE 1756
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1200
Practice Address - Country:US
Practice Address - Phone:617-892-8503
Practice Address - Fax:617-262-4021
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 188821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics