Provider Demographics
NPI:1477783728
Name:BAGLEY, THOMAS J (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BAGLEY
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 1:2729 HORSE PEN CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8395
Mailing Address - Country:US
Mailing Address - Phone:336-854-5850
Mailing Address - Fax:
Practice Address - Street 1:2729 HORSE PEN CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8395
Practice Address - Country:US
Practice Address - Phone:336-854-5850
Practice Address - Fax:336-854-1054
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist