Provider Demographics
NPI:1497770523
Name:THOMAS, JOHN B JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2935
Mailing Address - Country:US
Mailing Address - Phone:402-331-9500
Mailing Address - Fax:
Practice Address - Street 1:8601 HARRISON ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2935
Practice Address - Country:US
Practice Address - Phone:402-331-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice