Provider Demographics
NPI:1477636165
Name:THOMAS, MARC A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
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 1:4850 VISTA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2862
Mailing Address - Country:US
Mailing Address - Phone:775-626-3535
Mailing Address - Fax:
Practice Address - Street 1:4850 VISTA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2862
Practice Address - Country:US
Practice Address - Phone:775-626-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41219122300000X
NV48091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4809OtherNV DENTAL BOARD
CA41219OtherDENTAL BOARD LIC NUMBER
CABT4788951OtherDEA
NVFT0700143OtherDEA