MEDICARE: PRIYA M THOMAS DDS

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
1	122300000X	Dentist	2901019059	MI
2	122300000X	Dentist	12011041A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669422127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYA M THOMAS DDS

Provider Business Mailing Address
First Line	:	1121 W MICHIGAN STREET
Second Line	:	DS307B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5186
Country	:	US
Telephone Number	:	317-278-3632
Fax Number	:	317-274-2603

Provider Business Practice Location Address
First Line	:	1121 W MICHIGAN STEET
Second Line	:	DS307B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5186
Country	:	US
Telephone Number	:	317-278-3632
Fax Number	:	317-274-2603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/17/2015

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Directions to “ PRIYA M THOMAS DDS” Practice Location

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