=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750553046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS F. PLUMMER, III, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2008
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90-53 SUTPHIN BLVD 2ND FLOOR
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-6050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 CHITTENDEN AVENUE
-----------------------------------------------------
City | CRESTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10707-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-337-6219
-----------------------------------------------------
Fax | 914-771-5216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS F. PLUMMER III
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-739-6050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 038194
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------