Provider Demographics
NPI:1053465690
Name:DAVID R. THOMASON, D.M.D.,PC
Entity Type:Organization
Organization Name:DAVID R. THOMASON, D.M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-790-3011
Mailing Address - Street 1:3136 DEANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9348
Mailing Address - Country:US
Mailing Address - Phone:706-790-3011
Mailing Address - Fax:
Practice Address - Street 1:3136 DEANS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9348
Practice Address - Country:US
Practice Address - Phone:706-790-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
813058OtherUNITED CONCORDIA