Provider Demographics
NPI:1386654127
Name:BENNETT A. THOMAS D.D.S.,P.C.
Entity Type:Organization
Organization Name:BENNETT A. THOMAS D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDIE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH,BS
Authorized Official - Phone:757-548-3238
Mailing Address - Street 1:1300 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7414
Mailing Address - Country:US
Mailing Address - Phone:757-548-3238
Mailing Address - Fax:757-547-0679
Practice Address - Street 1:1300 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7414
Practice Address - Country:US
Practice Address - Phone:757-548-3238
Practice Address - Fax:757-547-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA71661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty