Healthcare Provider Details

I. General information

NPI: 1902015084
Provider Name (Legal Business Name): THOMAS K NASSER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A N MERIDIAN ST SUITE 300
CARMEL IN
46032-4406
US

IV. Provider business mailing address

12188A N MERIDIAN ST SUITE 300
CARMEL IN
46032-4406
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-7833
  • Fax: 317-844-3142
Mailing address:
  • Phone: 317-844-7833
  • Fax: 317-844-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12009257
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: