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General NPI Number Information
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NPI Number | 1598992836
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Entity Type | Individual
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Provider Name | JONATHAN MAC THOMAS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2009
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 1280 S KIHEI RD SUITE 209
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City | KIHEI
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State | HI
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Zip | 96753-8240
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Country | US
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Telephone | 808-879-1944
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Fax | 808-874-6187
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | KIHEI
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State | HI
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Zip | 96753-0869
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Country | US
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Telephone | 808-879-1944
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Fax | 808-874-6187
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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 | DT-2366
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License Number State | HI
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