Organization
NOMELAND DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THAMAS JASON NOMELAND D.D.S. (PRESIDENT)
(507) 334-7595
Entity
Organization
Contact information
Practice address
412 HERITAGE PL, FARIBAULT, MN 55021-5248
(507) 334-7595
Mailing address
412 HERITAGE PL, FARIBAULT, MN 55021-5248
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11041
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1415467
UNITED CONCORDIA
MN
Enumeration date
04/11/2007
Last updated
08/22/2020
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