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General NPI Number Information
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NPI Number | 1619539210
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Entity Type | Individual
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Provider Name | ANGELIQUE THOMAS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 18860 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2666
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Country | US
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Telephone | 248-565-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 29930 HYACINTH DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2086
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Country | US
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Telephone | 248-320-1701
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901022862
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License Number State | MI
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