Provider Demographics
NPI:1528234325
Name:DR. CLARENCE L. THOMAS III, D.D.S.
Entity type:Organization
Organization Name:DR. CLARENCE L. THOMAS III, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-372-4454
Mailing Address - Street 1:442 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2234
Mailing Address - Country:US
Mailing Address - Phone:937-372-4454
Mailing Address - Fax:937-372-5994
Practice Address - Street 1:442 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2234
Practice Address - Country:US
Practice Address - Phone:937-372-4454
Practice Address - Fax:937-372-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021080122300000X
OH19941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty