Provider Demographics
NPI:1134296056
Name:THOMAS, FAIRLY (DMD)
Entity Type:Individual
Prefix:
First Name:FAIRLY
Middle Name:
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 1:13 WYNDOM CT
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2511
Mailing Address - Country:US
Mailing Address - Phone:302-235-7151
Mailing Address - Fax:610-459-9752
Practice Address - Street 1:98 ROUTE 202 AT PA DE LINE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317
Practice Address - Country:US
Practice Address - Phone:610-459-4915
Practice Address - Fax:610-459-9752
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS03038211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice