Provider Demographics
NPI:1366577124
Name:KELLOGG, THOMAS M (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:KELLOGG
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 1:1250 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1007
Mailing Address - Country:US
Mailing Address - Phone:517-546-3330
Mailing Address - Fax:517-548-0192
Practice Address - Street 1:1250 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1007
Practice Address - Country:US
Practice Address - Phone:517-546-3330
Practice Address - Fax:517-548-0192
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI135431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice