Individual
DR. MICHAEL THOMAS TOM
Active
Sole proprietor
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
07/08/2007
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