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General NPI Number Information
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NPI Number | 1831220888
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Entity Type | Organization
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Legal Business Name | THOMAS W. MABRY, D.D.S., P.C.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1241 7TH ST SUITE A
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City | SLIDELL
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State | LA
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Zip | 70458-2041
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Country | US
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Telephone | 985-646-1421
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 7TH ST
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City | SLIDELL
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State | LA
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Zip | 70458-2041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS W. MABRY
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Credential |
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Telephone | 985-646-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3713
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License Number State | LA
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