MEDICARE: DR. THOMAS JEFF YANIK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6628	CT

General Provider Information

NPI Number	:	1356594410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JEFF YANIK DDS

Provider Business Mailing Address
First Line	:	2 CONCORDE WAY
Second Line	:	SUITE 1
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-1576
Country	:	US
Telephone Number	:	860-623-1116
Fax Number	:	860-627-5133

Provider Business Practice Location Address
First Line	:	2 CONCORDE WAY
Second Line	:	SUITE 1
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-1576
Country	:	US
Telephone Number	:	860-623-1116
Fax Number	:	860-627-5133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	11/02/2008

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