Provider Demographics
NPI:1548370307
Name:KOLDERMAN, THOMAS WINDT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WINDT
Last Name:KOLDERMAN
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 1:1545 KINGSWAY CT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1952
Mailing Address - Country:US
Mailing Address - Phone:734-676-1161
Mailing Address - Fax:734-676-0830
Practice Address - Street 1:1545 KINGSWAY CT
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1952
Practice Address - Country:US
Practice Address - Phone:734-676-1161
Practice Address - Fax:737-676-0830
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist