Provider Demographics
NPI:1376978452
Name:MISTRY, THAMAR PETIT (DMD)
Entity Type:Individual
Prefix:DR
First Name:THAMAR
Middle Name:PETIT
Last Name:MISTRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:THAMAR
Other - Middle Name:
Other - Last Name:PETIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:116 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1474
Mailing Address - Country:US
Mailing Address - Phone:717-801-4879
Mailing Address - Fax:
Practice Address - Street 1:116 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1474
Practice Address - Country:US
Practice Address - Phone:717-845-8617
Practice Address - Fax:717-854-0377
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0421301223G0001X
MD15485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS042130OtherDENTAL LICENSE