Healthcare Provider Details

I. General information

NPI: 1477247252
Provider Name (Legal Business Name): DALLIN RAY THOMAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR BLDG 2
CHAPEL HILL NC
27514-4423
US

IV. Provider business mailing address

304 COLT HWY APT 31
FARMINGTON CT
06032-3075
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-7835
  • Fax: 984-974-0290
Mailing address:
  • Phone: 970-231-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: