Provider Demographics
NPI:1861583148
Name:THOMAS DENTAL CENTER
Entity type:Organization
Organization Name:THOMAS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIONN
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-764-6149
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1490
Mailing Address - Country:US
Mailing Address - Phone:912-764-6149
Mailing Address - Fax:912-764-3863
Practice Address - Street 1:219 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2001
Practice Address - Country:US
Practice Address - Phone:912-764-6149
Practice Address - Fax:912-764-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty