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NPI Code Detail

MEDICARE: DR. GRACE THOMAS D.D.S.

MEDICARE: DR. GRACE THOMAS D.D.S.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)4052ME

General Provider Information

NPI Number : 1588876908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE THOMAS D.D.S.
Provider Business Mailing Address
First Line : 171 MAINE MALL RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2310
Country : US
Telephone Number : 207-775-1551
Fax Number :
Provider Business Practice Location Address
First Line : 171 MAINE MALL RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2310
Country : US
Telephone Number : 207-775-1551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2007
Last Update Date : 11/28/2007

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