Healthcare Provider Details

I. General information

NPI: 1831352822
Provider Name (Legal Business Name): THOMAS DANIEL TWILLEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS DANIEL TWILLEY D.M.D.

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 BIG A RD
TOCCOA GA
30577-6027
US

IV. Provider business mailing address

1061 BIG A RD
TOCCOA GA
30577-6027
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-1424
  • Fax: 706-282-4061
Mailing address:
  • Phone: 706-886-1424
  • Fax: 706-282-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number013340
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: