1538220140 NPI number — DR. THOMAS NELSON WANAT JR. DMD

Table of content: DR. THOMAS NELSON WANAT JR. DMD (NPI 1538220140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538220140 NPI number — DR. THOMAS NELSON WANAT JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANAT
Provider First Name:
THOMAS
Provider Middle Name:
NELSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
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:
1538220140
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:
20313 NEW ENGLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE RIVER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99577-7114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-696-1069
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3340 PROVIDENCE DR
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-562-6648
Provider Business Practice Location Address Fax Number:
907-561-8385
Provider Enumeration Date:
12/13/2006

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:  AK986 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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