Provider Demographics
NPI:1306025457
Name:THICKETT, THOMAS MILTON (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MILTON
Last Name:THICKETT
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 1:90 WOODACRE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132
Mailing Address - Country:US
Mailing Address - Phone:415-584-6300
Mailing Address - Fax:415-584-6301
Practice Address - Street 1:90 WOODACRE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132
Practice Address - Country:US
Practice Address - Phone:415-584-6300
Practice Address - Fax:415-584-6301
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0321871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice