Healthcare Provider Details

I. General information

NPI: 1689689382
Provider Name (Legal Business Name): THOMAS J. YANIK, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CONCORDE WAY BLDG #1
WINDSOR LOCKS CT
06096-1576
US

IV. Provider business mailing address

2 CONCORDE WAY BLDG #1
WINDSOR LOCKS CT
06096-1576
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-1116
  • Fax: 860-627-5133
Mailing address:
  • Phone: 860-623-1116
  • Fax: 860-627-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6628
License Number StateCT

VIII. Authorized Official

Name: DR. THOMAS J. YANIK
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 860-623-1116