Healthcare Provider Details

I. General information

NPI: 1790792521
Provider Name (Legal Business Name): DOUGLAS EUGENE THOMAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 E PINNACLE PEAK RD SUITE A-100
SCOTTSDALE AZ
85255-3406
US

IV. Provider business mailing address

7500 E PINNACLE PEAK RD SUITE A-100
SCOTTSDALE AZ
85255-3406
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-2824
  • Fax: 480-585-2391
Mailing address:
  • Phone: 480-585-2824
  • Fax: 480-585-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD5158
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: