Provider Demographics
NPI:1023009750
Name:POPP, THOMAS W (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:POPP
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3113
Mailing Address - Country:US
Mailing Address - Phone:423-870-8787
Mailing Address - Fax:423-875-6489
Practice Address - Street 1:4211 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3113
Practice Address - Country:US
Practice Address - Phone:423-870-8787
Practice Address - Fax:423-875-6489
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41251223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty