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General NPI Number Information
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NPI Number | 1285896530
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Entity Type | Organization
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Legal Business Name | THOMAS DENTAL OFFICE PC
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 3737 N KINGSHIGHWAY BLVD SUITE 108
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1736
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Country | US
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Telephone | 314-389-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 N KINGSHIGHWAY BLVD SUITE 108
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1736
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Country | US
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Telephone | 314-389-7722
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Fax |
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Authorized Official
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Title or Position | DENTAL ASSISTANT
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Name | MS. DOROTHY J DEAVAULT
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Credential |
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Telephone | 314-389-9990
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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 | 12970
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License Number State | MO
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