Provider Demographics
NPI:1073841268
Name:THOMAS, JAMES WYLIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WYLIE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 W 5400 S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1431
Mailing Address - Country:US
Mailing Address - Phone:801-969-6740
Mailing Address - Fax:
Practice Address - Street 1:2195 W 5400 S
Practice Address - Street 2:SUITE 203
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1431
Practice Address - Country:US
Practice Address - Phone:801-969-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-26
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7445398-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics