Provider Demographics
NPI:1164575882
Name:THOMASON, SAMUEL KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:KEITH
Last Name:THOMASON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-2841
Mailing Address - Country:US
Mailing Address - Phone:706-335-4222
Mailing Address - Fax:706-335-3682
Practice Address - Street 1:1397 S ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2841
Practice Address - Country:US
Practice Address - Phone:706-335-4222
Practice Address - Fax:706-335-3682
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist