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NPI Code Detail

MEDICARE: KEVIN MAMOOTTIL THOMAS

MEDICARE: KEVIN MAMOOTTIL THOMAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD012634AZ
2122300000XDentist063927NY

General Provider Information

NPI Number : 1497462147
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN MAMOOTTIL THOMAS
Provider Business Mailing Address
First Line : 1727 E PECOS RD APT 4079
Second Line :
City : GILBERT
State : AZ
Zip : 85295-1879
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10 W ADAMS ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85003-2025
Country : US
Telephone Number : 602-207-8528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2022
Last Update Date : 03/10/2026

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Directions to “ KEVIN MAMOOTTIL THOMAS ” Practice Location

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