Provider Demographics
NPI:1275618456
Name:LLEWELLYN, THOMAS CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7526
Mailing Address - Country:US
Mailing Address - Phone:410-821-0100
Mailing Address - Fax:410-821-0112
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7526
Practice Address - Country:US
Practice Address - Phone:410-821-0100
Practice Address - Fax:410-821-0112
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist