Organization
THOMAS A CLOSURDO JR DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A CLOSURDO JR. D.D.S (PRESIDENT)
(574) 288-1900
Entity
Organization
Contact information
Practice address
211 N SAINT PETER ST, SOUTH BEND, IN 46617-2823
(574) 288-1900
Mailing address
211 N SAINT PETER ST, SOUTH BEND, IN 46617-2823
(574) 288-1900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011946
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201200360
—
IN
Enumeration date
04/16/2015
Last updated
04/16/2015
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