Provider Demographics
NPI:1083039135
Name:THOMASVILLE FAMILY DENTIST, P. C.
Entity Type:Organization
Organization Name:THOMASVILLE FAMILY DENTIST, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOUDENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-636-2774
Mailing Address - Street 1:325 ALABAMA AVE W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3105
Mailing Address - Country:US
Mailing Address - Phone:334-636-2774
Mailing Address - Fax:334-636-2799
Practice Address - Street 1:325 ALABAMA AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3105
Practice Address - Country:US
Practice Address - Phone:334-636-2774
Practice Address - Fax:334-636-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty