Provider Demographics
NPI:1508910902
Name:THOMAS, MICHAEL EMETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMETT
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 1:1093 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5904
Mailing Address - Country:US
Mailing Address - Phone:928-704-0440
Mailing Address - Fax:928-704-0442
Practice Address - Street 1:1093 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5904
Practice Address - Country:US
Practice Address - Phone:928-704-0440
Practice Address - Fax:928-704-0442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD46061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics