Provider Demographics
NPI:1225326861
Name:THOMSON DENTAL, P.C.
Entity Type:Organization
Organization Name:THOMSON DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:VINTON
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-823-1654
Mailing Address - Street 1:1913 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1834
Mailing Address - Country:US
Mailing Address - Phone:205-823-1654
Mailing Address - Fax:205-979-6122
Practice Address - Street 1:1913 LAUREL RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1834
Practice Address - Country:US
Practice Address - Phone:205-823-1654
Practice Address - Fax:205-979-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty