Provider Demographics
NPI:1427332758
Name:THAYER, TODD ANTHONY (DDS, MS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ANTHONY
Last Name:THAYER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6556
Mailing Address - Country:US
Mailing Address - Phone:651-488-5622
Mailing Address - Fax:651-489-2856
Practice Address - Street 1:1050 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6556
Practice Address - Country:US
Practice Address - Phone:651-488-5622
Practice Address - Fax:651-489-2856
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics