Provider Demographics
NPI:1164423737
Name:THOMAS, GINA JORRAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:JORRAINE
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:URB.MUNOZ RIVERA
Mailing Address - Street 2:5 CALLE ACERINA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-4267
Mailing Address - Fax:787-720-7717
Practice Address - Street 1:5 CALLE ACERINA
Practice Address - Street 2:URB MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3514
Practice Address - Country:US
Practice Address - Phone:787-720-4267
Practice Address - Fax:787-720-7717
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice