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General NPI Number Information
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NPI Number | 1194241018
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 970 CAMERADO DR STE 100
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City | CAMERON PARK
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State | CA
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Zip | 95682-7636
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Country | US
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Telephone | 530-677-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 BYRNE CT
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City | FOLSOM
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State | CA
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Zip | 95630-8428
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Country | US
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Telephone | 801-376-9136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DDS104459
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5488428-9922
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00203286
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License Number State | CO
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