Provider Demographics
NPI:1396393617
Name:THOMAS, CHRISTOPHER DERRICK (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DERRICK
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 1:140 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6937
Mailing Address - Country:US
Mailing Address - Phone:865-276-1919
Mailing Address - Fax:865-276-1917
Practice Address - Street 1:140 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6937
Practice Address - Country:US
Practice Address - Phone:865-276-1919
Practice Address - Fax:265-276-1917
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000110751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty