1043431810 NPI number — THOMAS PAUL SODANO D.D.S.

Table of content: THOMAS PAUL SODANO D.D.S. (NPI 1043431810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043431810 NPI number — THOMAS PAUL SODANO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SODANO
Provider First Name:
THOMAS
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043431810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6985 C.R.327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARRETT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46738-9765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-637-8556
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14932 LIMA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46748-9275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-637-5848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12008985 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)