Provider Demographics
NPI:1346382892
Name:THOMAS F. MENTON D.D.S..
Entity Type:Organization
Organization Name:THOMAS F. MENTON D.D.S..
Other - Org Name:MENTON FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:410-740-9400
Mailing Address - Street 1:5126 DORSEY HALL DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7887
Mailing Address - Country:US
Mailing Address - Phone:410-740-9400
Mailing Address - Fax:410-740-2105
Practice Address - Street 1:5126 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7887
Practice Address - Country:US
Practice Address - Phone:410-740-9400
Practice Address - Fax:410-740-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty