Provider Demographics
NPI:1194737692
Name:BIRONG, THOMAS J (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BIRONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 TRUMP ROAD
Mailing Address - Street 2:ST 300
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615
Mailing Address - Country:US
Mailing Address - Phone:330-627-5666
Mailing Address - Fax:330-627-7889
Practice Address - Street 1:1040 TRUMP ROAD
Practice Address - Street 2:ST A
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615
Practice Address - Country:US
Practice Address - Phone:330-627-5666
Practice Address - Fax:330-627-7889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.021453332B00000X
OH21453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2387251Medicaid