Provider Demographics
NPI:1346257086
Name:SMITH, THOMAS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 SEMINOLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4721
Mailing Address - Country:US
Mailing Address - Phone:231-780-5334
Mailing Address - Fax:231-780-5335
Practice Address - Street 1:755 SEMINOLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4721
Practice Address - Country:US
Practice Address - Phone:231-780-5334
Practice Address - Fax:231-780-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010150681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice