MEDICARE: THOMAS & THOMAS DENTAL, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4589	AZ

General Provider Information

NPI Number	:	1720200587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS & THOMAS DENTAL, LTD.

Provider Business Mailing Address
First Line	:	7150 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5300
Country	:	US
Telephone Number	:	602-230-0811
Fax Number	:	602-230-7735

Provider Business Practice Location Address
First Line	:	7150 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5300
Country	:	US
Telephone Number	:	602-230-0811
Fax Number	:	602-230-7735

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTINE THOMAS
Credential	:	DMD
Telephone Number	:	602-230-0811

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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