Provider Demographics
NPI:1548907355
Name:DOFREDO, THOMAS ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:DOFREDO
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 1:2101 CHARLOTTE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2764
Mailing Address - Country:US
Mailing Address - Phone:816-404-4356
Mailing Address - Fax:816-404-4359
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:215-503-6215
Practice Address - Fax:816-404-4359
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043775122300000X
390200000X
MO2023021075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program