Healthcare Provider Details

I. General information

NPI: 1134227275
Provider Name (Legal Business Name): JOHN EDWARD THOMAS SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

2716 NW 32ND ST
GAINESVILLE FL
32605-2780
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-4040
  • Fax:
Mailing address:
  • Phone: 352-372-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN8762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: