Provider Demographics
NPI:1538494240
Name:THOMAS, CANDACE R (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:R
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:236 STOCKBRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3629
Mailing Address - Country:US
Mailing Address - Phone:678-619-2467
Mailing Address - Fax:
Practice Address - Street 1:236 STOCKBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3629
Practice Address - Country:US
Practice Address - Phone:678-619-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice