Healthcare Provider Details

I. General information

NPI: 1619042553
Provider Name (Legal Business Name): PHIL J THOMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 J F KENNEDY DRIVE
BELLEVUE NE
68005-3693
US

IV. Provider business mailing address

1411 J F KENNEDY DRIVE
BELLEVUE NE
68005-3693
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-3535
  • Fax: 402-291-0760
Mailing address:
  • Phone: 402-291-3535
  • Fax: 402-291-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4364
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: