Healthcare Provider Details

I. General information

NPI: 1871421586
Provider Name (Legal Business Name): NAMITA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11910 US HIGHWAY 290 E UNIT 420
MANOR TX
78653-0667
US

IV. Provider business mailing address

1010 SPRINGDALE RD UNIT 347
AUSTIN TX
78721-1965
US

V. Phone/Fax

Practice location:
  • Phone: 512-716-8167
  • Fax:
Mailing address:
  • Phone: 480-352-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: