Provider Demographics
NPI:1104848340
Name:MOUNSDON, THOMAS ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:MOUNSDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:ALBERT
Other - Last Name:MOUNSDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:201 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1642
Mailing Address - Country:US
Mailing Address - Phone:641-446-7766
Mailing Address - Fax:
Practice Address - Street 1:201 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144-1642
Practice Address - Country:US
Practice Address - Phone:641-446-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0059493Medicaid