=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255749388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LETRISHA A. THOMAS DDS., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2014
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 FORUM BLVD SUITE B2
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-6343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-446-3848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 FORUM BLVD SUITE B2
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-6343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-446-3848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DIRECTOR
-----------------------------------------------------
Name | DR. LETRISHA ANN THOMAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 573-446-3848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2010019430
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------