Healthcare Provider Details

I. General information

NPI: 1386763837
Provider Name (Legal Business Name): JEFFERY R. THOMAS, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 VILLAGE WAY
TRENT WOODS NC
28562-7305
US

IV. Provider business mailing address

2808 VILLAGE WAY
TRENT WOODS NC
28562-7305
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-1631
  • Fax: 252-633-3922
Mailing address:
  • Phone: 252-633-1631
  • Fax: 252-633-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberPA#131486
License Number StateNC

VIII. Authorized Official

Name: DR. JEFFERY R THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 252-633-1631