Provider Demographics
NPI:1316773450
Name:THOMAS J READEL DMD PLLC
Entity type:Organization
Organization Name:THOMAS J READEL DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:READEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-775-3484
Mailing Address - Street 1:508 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-9157
Mailing Address - Country:US
Mailing Address - Phone:817-625-0341
Mailing Address - Fax:817-625-1211
Practice Address - Street 1:508 W NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-9157
Practice Address - Country:US
Practice Address - Phone:817-625-0341
Practice Address - Fax:817-625-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty