Provider Demographics
NPI:1306183736
Name:MARC D. THOMAS DDS, PC
Entity Type:Organization
Organization Name:MARC D. THOMAS DDS, PC
Other - Org Name:CANYON RIDGE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-841-7900
Mailing Address - Street 1:19551 HESS RD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3446
Mailing Address - Country:US
Mailing Address - Phone:303-841-7900
Mailing Address - Fax:303-841-1650
Practice Address - Street 1:19551 HESS RD UNIT 110
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3446
Practice Address - Country:US
Practice Address - Phone:303-841-7900
Practice Address - Fax:303-841-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46455035Medicaid