Individual
DR. MICHAEL THOMAS TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1220 MEDICAL PARK DR, STE 1, FORT WAYNE, IN 46825-5843
(260) 482-9196
(260) 484-3371
Mailing address
1220 MEDICAL PARK DR, STE 1, FORT WAYNE, IN 46825-5843
(260) 482-9196
(260) 484-3371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010084A
IN
Other
Enumeration date
06/17/2005
Last updated
07/13/2026
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