Individual
THOMAS J FORMANACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
17775 MASON ST, SUITE 1, OMAHA, NE 68118-3559
(402) 758-9399
(402) 758-0030
Mailing address
16597 HASCALL ST, OMAHA, NE 68130-2060
(402) 697-9401
(402) 758-0030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4024
NE
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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