Provider Demographics
NPI:1326642943
Name:THOMAS DENTAL GROUP PA
Entity Type:Organization
Organization Name:THOMAS DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-261-3713
Mailing Address - Street 1:1150 MONTREAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2393
Mailing Address - Country:US
Mailing Address - Phone:651-224-0001
Mailing Address - Fax:
Practice Address - Street 1:1150 MONTREAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2393
Practice Address - Country:US
Practice Address - Phone:651-224-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1861849176OtherDENTAL
MN1336296409OtherDENTAL