Provider Demographics
NPI:1144211038
Name:DELANEY, THOMAS CHARLES (D,M,D,)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:DELANEY
Suffix:
Gender:M
Credentials:D,M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W PEARCE BLVD
Mailing Address - Street 2:STE. 110
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1053
Mailing Address - Country:US
Mailing Address - Phone:636-327-5188
Mailing Address - Fax:636-332-9223
Practice Address - Street 1:1126 W PEARCE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1053
Practice Address - Country:US
Practice Address - Phone:636-327-5188
Practice Address - Fax:636-332-9223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice