Provider Demographics
NPI:1093947582
Name:THOMAS, JUDE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:A
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 1:6020 LOUISVILLE ST
Mailing Address - Street 2:NIMISHILLEN CREEK DENTAL
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9484
Mailing Address - Country:US
Mailing Address - Phone:330-875-1688
Mailing Address - Fax:
Practice Address - Street 1:6020 LOUISVILLE ST
Practice Address - Street 2:NIMISHILLEN CREEK DENTAL
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9484
Practice Address - Country:US
Practice Address - Phone:330-875-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300230961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice