Healthcare Provider Details

I. General information

NPI: 1982447892
Provider Name (Legal Business Name): DR. RESHMA ELIZABETH THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-18
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

17538 12TH AVE NE APT B416
SHORELINE WA
98155-3756
US

V. Phone/Fax

Practice location:
  • Phone: 352-272-6741
  • Fax:
Mailing address:
  • Phone: 425-503-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDRPM2753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: