Provider Demographics
NPI:1518263300
Name:THOMAS, IAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:S
Last Name:THOMAS
Suffix:
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 1:30 N BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2503
Mailing Address - Country:US
Mailing Address - Phone:610-544-0120
Mailing Address - Fax:610-544-1563
Practice Address - Street 1:30 N BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2503
Practice Address - Country:US
Practice Address - Phone:610-544-0120
Practice Address - Fax:610-544-1563
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0377841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics