Provider Demographics
NPI:1902098122
Name:VERDONI, THOMAS ANGELO (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANGELO
Last Name:VERDONI
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 1:51 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2165
Mailing Address - Country:US
Mailing Address - Phone:718-564-5432
Mailing Address - Fax:718-486-3297
Practice Address - Street 1:51 WILSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2165
Practice Address - Country:US
Practice Address - Phone:718-564-5432
Practice Address - Fax:718-486-3297
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02545811Medicaid