Provider Demographics
NPI:1447242631
Name:SYDLOWSKI, THOMAS P (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:SYDLOWSKI
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 1:4646 NANTUCKET DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3194
Mailing Address - Country:US
Mailing Address - Phone:419-843-2121
Mailing Address - Fax:419-517-2104
Practice Address - Street 1:1850 EASTGATE RD
Practice Address - Street 2:STE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3082
Practice Address - Country:US
Practice Address - Phone:419-385-5743
Practice Address - Fax:419-385-8835
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-75511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576112Medicaid
OH000000127872OtherANTHEM BC
OH190009411OtherRR MEDICARE
OH850000129OtherRR MEDICARE
OH190009411OtherRR MEDICARE
T48199Medicare UPIN
OH0566365Medicare PIN
OH0566364Medicare PIN