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1114831302 NPI number — TREVOR JAMAL THOMAS DDS DC PLLC

NPI Number: 1114831302
Health Care Provider/Practitioner: TREVOR JAMAL THOMAS DDS DC PLLC

Information about “1114831302” NPI (TREVOR JAMAL THOMAS DDS DC PLLC) exists in 1114831302 in HTML format HTML  |  1114831302 in plain Text format TXT  |  1114831302 in PDF (Portable Document Format) PDF  |  1114831302 in an XML format XML  formats.

NPI Number : 1114831302 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114831302",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TREVOR JAMAL THOMAS DDS DC PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "572 HANK AARON DR SE STE 4100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATLANTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30312-2899",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "424-448-2862",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1010 QUINCY ST NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WASHINGTON",
    "PracticeLocationAddressStateName": "DC",
    "PracticeLocationAddressPostalCode": "20017-1738",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "424-448-2862",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/02/2026",
    "LastUpdateDate": "10/02/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AQUINO",
    "AuthorizedOfficialFirstName": "VIOLET",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "424-448-2862",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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