Provider Demographics
NPI:1497920904
Name:DR. PAUL THOMAS
Entity Type:Organization
Organization Name:DR. PAUL THOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PEAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-237-2543
Mailing Address - Street 1:621 S. HARDING STE B
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-237-2543
Mailing Address - Fax:580-233-3186
Practice Address - Street 1:621 S HARDING ST STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-6319
Practice Address - Country:US
Practice Address - Phone:580-237-2543
Practice Address - Fax:580-233-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty