Provider Demographics
NPI:1225040769
Name:SHOLAR, THOMAS MERRIMON (DDS,OLLC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MERRIMON
Last Name:SHOLAR
Suffix:
Gender:M
Credentials:DDS,OLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1416
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-1416
Mailing Address - Country:US
Mailing Address - Phone:704-663-7035
Mailing Address - Fax:704-799-3202
Practice Address - Street 1:520 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2546
Practice Address - Country:US
Practice Address - Phone:704-663-7035
Practice Address - Fax:704-799-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7997782Medicaid