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General NPI Number Information
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NPI Number | 1457675738
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Entity Type | Organization
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Legal Business Name | THOMAS ORTHODONTICS
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 424 STATE ROAD 198
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City | SALEM
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State | UT
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Zip | 84653-4605
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Country | US
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Telephone | 801-423-3030
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Fax | 801-423-3034
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Provider Business Mailing Address
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Address Line | 424 STATE ROAD 198
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City | SALEM
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State | UT
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Zip | 84653-4605
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Country | US
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Telephone | 801-423-3030
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Fax | 801-423-3034
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JAMES WYLIE THOMAS
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Credential | D.M.D.
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Telephone | 801-423-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7445398-9921
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License Number State | UT
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