Healthcare Provider Details

I. General information

NPI: 1659483782
Provider Name (Legal Business Name): THOMAS W. PARISH JR. DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W. MAPLE AVE
GENEVA AL
36340
US

IV. Provider business mailing address

706 W. MAPLE AVE
GENEVA AL
36340
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3096
  • Fax: 334-684-2828
Mailing address:
  • Phone: 334-684-3096
  • Fax: 334-684-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS W. PARISH JR.
Title or Position: OWNER
Credential: DMD
Phone: 334-684-3096