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Organization
THOMAS M. PEDAVOLI DDS INC.
Active
Organization
THOMAS M. PEDAVOLI DDS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MICHAEL PEDAVOLI DDS (OWNER/DENTIST)
(574) 936-2527
Entity
Organization
Contact information
Practice address
850 COLUMBUS DR, PLYMOUTH, IN 46563-1877
(574) 936-2527
(574) 936-5363
Mailing address
PO BOX 1049, PLYMOUTH, IN 46563-5049
(574) 936-2527
(574) 936-5363
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008862A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LPI 100323350 B
—
IN
Enumeration date
02/27/2017
Last updated
02/27/2017
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