Provider Demographics
NPI:1356653703
Name:THOMAS, LETRISHA ANN (DDS)
Entity Type:Individual
Prefix:
First Name:LETRISHA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 W HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3156
Mailing Address - Country:US
Mailing Address - Phone:660-263-8181
Mailing Address - Fax:660-263-4154
Practice Address - Street 1:1013 W HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3156
Practice Address - Country:US
Practice Address - Phone:660-263-8181
Practice Address - Fax:660-263-4154
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100194301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice