Provider Demographics
NPI:1205045150
Name:THOMAS, ALONZO THEODORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALONZO
Middle Name:THEODORE
Last Name:THOMAS
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 1:11247 LOCKWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4561
Mailing Address - Country:US
Mailing Address - Phone:301-681-6306
Mailing Address - Fax:301-681-6101
Practice Address - Street 1:11247 LOCKWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4561
Practice Address - Country:US
Practice Address - Phone:301-681-6306
Practice Address - Fax:301-681-6101
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice