Provider Demographics
NPI:1275598096
Name:TRIPP, THOMAS JAROM (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAROM
Last Name:TRIPP
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 1:2920 OAK RD APT 2104
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8823
Mailing Address - Country:US
Mailing Address - Phone:214-518-3856
Mailing Address - Fax:
Practice Address - Street 1:5341 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4909
Practice Address - Country:US
Practice Address - Phone:713-574-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310222001Medicaid