Healthcare Provider Details

I. General information

NPI: 1780614883
Provider Name (Legal Business Name): THOMAS P NORDONE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 S BRYN MAWR AVE
BRYN MAWR PA
19010-3201
US

IV. Provider business mailing address

26 S BRYN MAWR AVE
BRYN MAWR PA
19010-3201
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-3110
  • Fax: 610-520-0534
Mailing address:
  • Phone: 610-527-3110
  • Fax: 610-520-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS028977L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS021679L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: