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General NPI Number Information
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NPI Number | 1952672511
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Entity Type | Organization
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Legal Business Name | JACK B. THIGPEN, III, DMD, PA
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 10850 SHELDON RD
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City | TAMPA
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State | FL
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Zip | 33626-5117
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Country | US
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Telephone | 813-926-5989
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Fax | 813-926-0790
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Provider Business Mailing Address
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Address Line | 10850 SHELDON RD
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City | TAMPA
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State | FL
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Zip | 33626-5117
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Country | US
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Telephone | 813-926-5989
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Fax | 813-926-0790
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. TERESA L. COLBURN BIRD
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Credential |
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Telephone | 813-926-5989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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