Provider Demographics
NPI:1235011834
Name:THOMAS N WANAT III, DMD, MSD, LLC
Entity type:Organization
Organization Name:THOMAS N WANAT III, DMD, MSD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:WANAT
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:907-313-8918
Mailing Address - Street 1:2020 ABBOTT RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4624
Mailing Address - Country:US
Mailing Address - Phone:907-313-8918
Mailing Address - Fax:
Practice Address - Street 1:2020 ABBOTT RD STE 5
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4624
Practice Address - Country:US
Practice Address - Phone:907-313-8918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty