Provider Demographics
NPI:1326151051
Name:OAKLEY, THOMAS JACKSON III (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JACKSON
Last Name:OAKLEY
Suffix:III
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 1:746 TELL ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3148
Mailing Address - Country:US
Mailing Address - Phone:423-745-3559
Mailing Address - Fax:423-507-8217
Practice Address - Street 1:746 TELL ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3148
Practice Address - Country:US
Practice Address - Phone:423-745-3559
Practice Address - Fax:423-507-8217
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-43561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice