Healthcare Provider Details

I. General information

NPI: 1669624029
Provider Name (Legal Business Name): THOMAS GEORGE TZOMIDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 PLEASANTVILLE RD
FALLSTON MD
21047-2099
US

IV. Provider business mailing address

2404 PLEASANTVILLE RD
FALLSTON MD
21047-2099
US

V. Phone/Fax

Practice location:
  • Phone: 410-879-6688
  • Fax: 410-879-1673
Mailing address:
  • Phone: 410-879-6688
  • Fax: 410-879-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8693
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: