Provider Demographics
NPI:1154448231
Name:GANN, THOMAS (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:GANN
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1015
Mailing Address - Fax:205-930-1448
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-930-1015
Practice Address - Fax:205-930-1448
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-49797OtherBLUE CROSS BLUE SHIELD
AL510-49794OtherBLUE CROSS BLUE SHIELD
AL510-49798OtherBLUE CROSS BLUE SHIELD
AL113331Medicaid
AL114370Medicaid
AL510-49796OtherBLUE CROSS BLUE SHIELD