Provider Demographics
NPI:1194927897
Name:DAHLAN, THOMAS JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:DAHLAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 BIRD ROAD
Mailing Address - Street 2:SUITE 3A TO 3B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4882
Mailing Address - Country:US
Mailing Address - Phone:305-661-4088
Mailing Address - Fax:305-661-7088
Practice Address - Street 1:6262 BIRD ROAD
Practice Address - Street 2:SUITE 3A TO 3B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4882
Practice Address - Country:US
Practice Address - Phone:305-661-4088
Practice Address - Fax:305-661-7088
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist