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General NPI Number Information
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NPI Number | 1114199288
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Entity Type | Organization
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Legal Business Name | DR MARY THOMAS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 03/29/2008
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Last Update Date | 03/29/2008
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Provider Practice Location Address
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Address Line | 8770 CUYAMACA ST SUITE 2
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City | SANTEE
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State | CA
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Zip | 92071-4373
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Country | US
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Telephone | 619-258-1171
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Fax | 619-258-3553
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Provider Business Mailing Address
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Address Line | 8770 CUYAMACA ST SUITE 2
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City | SANTEE
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State | CA
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Zip | 92071-4373
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Country | US
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Telephone | 619-258-1171
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Fax | 619-258-3553
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Authorized Official
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Title or Position | CEO/DENTIST
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Name | DR. MARY THOMAS
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Credential | DDS
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Telephone | 619-258-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44269
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License Number State | CA
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