Provider Demographics
NPI:1033191051
Name:THOMASSON, MARK HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:THOMASSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E DUE WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5202
Mailing Address - Country:US
Mailing Address - Phone:615-685-1732
Mailing Address - Fax:615-865-9223
Practice Address - Street 1:106 E DUE WEST AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5202
Practice Address - Country:US
Practice Address - Phone:615-685-1732
Practice Address - Fax:615-865-9223
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice