Provider Demographics
NPI:1154669406
Name:GEOGHEGAN, THOMAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:GEOGHEGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 BUFORD HWY
Mailing Address - Street 2:BLDG. B, SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2800
Mailing Address - Country:US
Mailing Address - Phone:770-476-3332
Mailing Address - Fax:770-622-1577
Practice Address - Street 1:2785 BUFORD HWY
Practice Address - Street 2:BLDG. B, SUITE 101
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2800
Practice Address - Country:US
Practice Address - Phone:770-476-3332
Practice Address - Fax:770-622-1577
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist