Provider Demographics
NPI:1164553988
Name:THOMAS, KRISTINE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
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 1:7150 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5300
Mailing Address - Country:US
Mailing Address - Phone:602-230-0811
Mailing Address - Fax:602-230-7735
Practice Address - Street 1:7150 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5300
Practice Address - Country:US
Practice Address - Phone:602-230-0811
Practice Address - Fax:602-230-7735
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice