Individual provider Active NPI

Thomas Thalody, D.D.S.

  • General Practice Dentistry
  • Manchester, CT
National Provider Identifier
1093746935
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
008931 Issued in CT
Practice address
483 Middle Tpke W
Manchester, CT 06040-3863
Phone
(860) 645-0111
Fax
(860) 533-9027
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 008931 CT Primary

Addresses

Primary practice location

483 Middle Tpke W
Manchester, CT 06040-3863

Mailing address

5-4 Foncine LN
South Windsor, CT 06074-3688
Phone (860) 432-7825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150821013417 CT Order and Referring Only - DentistPractitioner - Dentist 9537474432

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008931CTMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1093746935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5-4 FONCINE LN",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743688",
            "telephone_number": "860-432-7825",
            "fax_number": "860-533-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 MIDDLE TPKE W",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403863",
            "telephone_number": "860-645-0111",
            "fax_number": "860-533-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALODY",
        "first_name": "THOMAS",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.