Healthcare Provider Details

I. General information

NPI: 1265578397
Provider Name (Legal Business Name): JONATHAN S. THOMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SW VILLA WEST DR SUITE B
TOPEKA KS
66614-4487
US

IV. Provider business mailing address

3033 SW VILLA WEST DR SUITE B
TOPEKA KS
66614-4487
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-0770
  • Fax: 785-272-0035
Mailing address:
  • Phone: 785-272-0770
  • Fax: 785-272-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number60298
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: