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General NPI Number Information
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NPI Number | 1528234325
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Entity Type | Organization
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Legal Business Name | DR. CLARENCE L. THOMAS III, D.D.S.
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 442 N DETROIT ST
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City | XENIA
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State | OH
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Zip | 45385-2234
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Country | US
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Telephone | 937-372-4454
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Fax | 937-372-5994
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Provider Business Mailing Address
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Address Line | 442 N DETROIT ST
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City | XENIA
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State | OH
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Zip | 45385-2234
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Country | US
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Telephone | 937-372-4454
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Fax | 937-372-5994
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLARENCE L THOMAS III
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Credential | DDS
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Telephone | 937-372-4454
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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 | 30021080
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License Number State | OH
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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 | 19941
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License Number State | OH
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