Provider Demographics
NPI:1225233232
Name:THOMAS, ANITA M (DDS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 CENTRAL AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3911
Mailing Address - Country:US
Mailing Address - Phone:763-757-8253
Mailing Address - Fax:763-757-5733
Practice Address - Street 1:11949 CENTRAL AVENUE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3911
Practice Address - Country:US
Practice Address - Phone:763-757-8253
Practice Address - Fax:763-757-5733
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist