Provider Demographics
NPI:1407961063
Name:SHEALY, THOMAS III (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHEALY
Suffix:III
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 1:34 STRATHAM HEIGHTS ROAD
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885
Mailing Address - Country:US
Mailing Address - Phone:603-772-2009
Mailing Address - Fax:603-772-2009
Practice Address - Street 1:2 RAEDER DRIVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885
Practice Address - Country:US
Practice Address - Phone:603-772-6260
Practice Address - Fax:603-775-7317
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15261223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health