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General NPI Number Information
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NPI Number | 1275759334
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Entity Type | Individual
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Provider Name | THOMAS MAXWELL THANEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 64 N MAIN ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1649
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Country | US
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Telephone | 585-637-6884
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Fax |
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Provider Business Mailing Address
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Address Line | 423 STONE FENCE RD
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City | ROCHESTER
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State | NY
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Zip | 14626-3187
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Country | US
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Telephone | 585-368-0694
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51292
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License Number State | NY
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