Provider Demographics
NPI:1073745725
Name:MICHAEL R THOMAS DDS
Entity Type:Organization
Organization Name:MICHAEL R THOMAS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-532-3353
Mailing Address - Street 1:1511 CARLSON ST.
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2626
Mailing Address - Country:US
Mailing Address - Phone:507-532-3353
Mailing Address - Fax:507-532-3485
Practice Address - Street 1:1511 CARLSON ST.
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2626
Practice Address - Country:US
Practice Address - Phone:507-532-3353
Practice Address - Fax:507-532-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83422900Medicaid