Provider Demographics
NPI:1043423841
Name:WA THAMES DMD PLLC
Entity Type:Organization
Organization Name:WA THAMES DMD PLLC
Other - Org Name:THAMES FAMILY DENTISTRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANI
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-895-7338
Mailing Address - Street 1:9035 E SANDIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3520
Mailing Address - Country:US
Mailing Address - Phone:662-895-7338
Mailing Address - Fax:662-895-7040
Practice Address - Street 1:9035 E SANDIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3520
Practice Address - Country:US
Practice Address - Phone:662-895-7338
Practice Address - Fax:662-895-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2182 851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty