Healthcare Provider Details

I. General information

NPI: 1194066688
Provider Name (Legal Business Name): THOMAS J DROCKTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 LANDERBROOK DR SUITE 222
MAYFIELD HTS OH
44124-6532
US

IV. Provider business mailing address

10640 CEDAR RD
CHESTERLAND OH
44026-3626
US

V. Phone/Fax

Practice location:
  • Phone: 216-752-8888
  • Fax:
Mailing address:
  • Phone: 440-376-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-024219
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: