Provider Demographics
NPI:1801920129
Name:FENLON, THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:FENLON
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 1:12800 FREDERICK RD
Mailing Address - Street 2:PO BOX 340
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9564
Mailing Address - Country:US
Mailing Address - Phone:410-442-2800
Mailing Address - Fax:
Practice Address - Street 1:12800 FREDERICK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST FRIENDSHIP
Practice Address - State:MD
Practice Address - Zip Code:21794-9564
Practice Address - Country:US
Practice Address - Phone:410-442-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice