Provider Demographics
NPI:1366448433
Name:THOMAS, LARRY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:THOMAS
Suffix:
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 1:1360 S ELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-4324
Mailing Address - Country:US
Mailing Address - Phone:931-359-1993
Mailing Address - Fax:931-359-7372
Practice Address - Street 1:1360 S ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-4324
Practice Address - Country:US
Practice Address - Phone:931-359-1993
Practice Address - Fax:931-359-7372
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND5052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225545Medicaid