Provider Demographics
NPI:1699875286
Name:NOREIKA, VIDAS THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:VIDAS
Middle Name:THOMAS
Last Name:NOREIKA
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 1:1232 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4856
Mailing Address - Country:US
Mailing Address - Phone:219-872-2116
Mailing Address - Fax:219-874-7087
Practice Address - Street 1:1232 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4856
Practice Address - Country:US
Practice Address - Phone:219-872-2116
Practice Address - Fax:219-874-7087
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009412A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice