Provider Demographics
NPI:1548433204
Name:THOMAS, KIM CANION (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:CANION
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 HONEA EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2392
Mailing Address - Country:US
Mailing Address - Phone:936-321-2580
Mailing Address - Fax:936-321-2581
Practice Address - Street 1:610 HONEA EGYPT RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2392
Practice Address - Country:US
Practice Address - Phone:936-321-2580
Practice Address - Fax:936-321-2581
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice