Provider Demographics
NPI:1366468860
Name:THAMES, DALE CLIFTON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:CLIFTON
Last Name:THAMES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1525 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4037
Mailing Address - Country:US
Mailing Address - Phone:307-672-3473
Mailing Address - Fax:307-675-3966
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:307-675-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS2368-871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice