Provider Demographics
NPI:1447420526
Name:THOMAS DDS PERIODONTAL SPECIALISTS
Entity Type:Organization
Organization Name:THOMAS DDS PERIODONTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-436-6767
Mailing Address - Street 1:209 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2721
Mailing Address - Country:US
Mailing Address - Phone:816-436-6767
Mailing Address - Fax:816-436-6766
Practice Address - Street 1:209 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2721
Practice Address - Country:US
Practice Address - Phone:816-436-6767
Practice Address - Fax:816-436-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS015600261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental