Provider Demographics
NPI:1881945525
Name:THYVALIKAKATH, THANKAM PAUL (DMD, PHD)
Entity type:Individual
Prefix:
First Name:THANKAM
Middle Name:PAUL
Last Name:THYVALIKAKATH
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 W MICHIGAN ST
Mailing Address - Street 2:DS307B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5186
Mailing Address - Country:US
Mailing Address - Phone:317-278-3632
Mailing Address - Fax:317-274-2603
Practice Address - Street 1:1121 W MICHIGAN ST
Practice Address - Street 2:DS285
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5186
Practice Address - Country:US
Practice Address - Phone:317-274-5628
Practice Address - Fax:317-274-2603
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist