Healthcare Provider Details

I. General information

NPI: 1356304059
Provider Name (Legal Business Name): RYAN E. THOMAS, D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 RED ARROW HWY
BRIDGMAN MI
49106
US

IV. Provider business mailing address

9151 RED ARROW HWY.
BRIDGMAN MI
49106
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-5151
  • Fax: 269-465-3836
Mailing address:
  • Phone: 269-465-5151
  • Fax: 269-465-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13825
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019616
License Number StateMI

VIII. Authorized Official

Name: RYAN E THOMAS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 269-465-5151