Provider Demographics
NPI:1093879231
Name:THOMAS, VINEETHA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINEETHA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 OLD YORK ROAD
Mailing Address - Street 2:SUITE B10
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1573
Mailing Address - Country:US
Mailing Address - Phone:215-887-7171
Mailing Address - Fax:215-885-5630
Practice Address - Street 1:8302 OLD YORK ROAD
Practice Address - Street 2:SUITE B10
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1573
Practice Address - Country:US
Practice Address - Phone:215-887-7171
Practice Address - Fax:215-885-5630
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024158L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA452630OtherUNITED CONCORDIA