=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053465690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID R. THOMASON, D.M.D.,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3136 DEANS BRIDGE RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-9348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-790-3011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3136 DEANS BRIDGE RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-9348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-790-3011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID R. THOMASON
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 706-790-3011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN009209
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------