Healthcare Provider Details

I. General information

NPI: 1689221129
Provider Name (Legal Business Name): DEAN ASHLEY THOMAS JR. D.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DEAN ASHLEY THOMAS JR. DJ THOMAS

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3427 N BIRMINGHAM AVE
TULSA OK
74110-1512
US

IV. Provider business mailing address

1218 W QUEEN ST
TULSA OK
74127-2502
US

V. Phone/Fax

Practice location:
  • Phone: 918-565-9746
  • Fax:
Mailing address:
  • Phone: 918-565-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: