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General NPI Number Information
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NPI Number | 1366758633
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH RYDZON DDS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 7024 SCENIC RDG
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City | CLARKSTON
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State | MI
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Zip | 48346-1345
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Country | US
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Telephone | 124-862-5934
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 S STATE RD SUITE A
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City | DAVISON
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State | MI
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Zip | 48423-8671
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Country | US
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Telephone | 810-653-3503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 09961
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License Number State | MI
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