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NPI Code Detail

MEDICARE: THOMAS DENTAL ACQUISITIONS, LLC

MEDICARE: THOMAS DENTAL ACQUISITIONS, LLC
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
1261QD0000XDental Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1700422458
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMAS DENTAL ACQUISITIONS, LLC
Provider Business Mailing Address
First Line : 6709 WHITE HORSE RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29611-2503
Country : US
Telephone Number : 864-246-0260
Fax Number : 864-484-9449
Provider Business Practice Location Address
First Line : 6709 WHITE HORSE RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29611-2503
Country : US
Telephone Number : 864-246-0260
Fax Number : 864-484-9449
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT THOMAS
Credential : DMD
Telephone Number : 864-246-0260
Provider Enumeration Date : 11/18/2019
Last Update Date : 11/18/2019

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