Provider Demographics
NPI:1144846411
Name:FLOYD, THOMAS JAMES (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:FLOYD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 TREASURE CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9699
Mailing Address - Country:US
Mailing Address - Phone:260-579-7349
Mailing Address - Fax:
Practice Address - Street 1:4716 ILLINOIS RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5123
Practice Address - Country:US
Practice Address - Phone:260-432-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN12013443A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program