| Thomas M. Pedavoli Dds Inc. | |
|
850 Columbus Dr Plymouth IN 46563-1877 | |
| (574) 936-2527 | |
| (574) 936-5363 |
| Full Name | Thomas M. Pedavoli Dds Inc. |
|---|---|
| Speciality | Dentist |
| Location | 850 Columbus Dr, Plymouth, Indiana |
| Authorized Official Name and Position | Thomas Michael Pedavoli (OWNER/DENTIST) |
| Authorized Official Contact | 5749362527 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas M. Pedavoli Dds Inc. Po Box 1049 Plymouth IN 46563-5049 Ph: (574) 936-2527 | Thomas M. Pedavoli Dds Inc. 850 Columbus Dr Plymouth IN 46563-1877 Ph: (574) 936-2527 |
| NPI Number | 1215477088 |
|---|---|
| Provider Enumeration Date | 02/27/2017 |
| Last Update Date | 02/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215477088 | NPI | - | NPPES |
| LPI 100323350 B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12008862A (Indiana) | Primary |
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