Provider Demographics
NPI: | 1528019114 |
---|---|
Name: | THOMAS DENTAL CARE, P.C. |
Entity Type: | Organization |
Organization Name: | THOMAS DENTAL CARE, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DIRK |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | THOMAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 918-376-2700 |
Mailing Address - Street 1: | 12406 E 86TH ST N |
Mailing Address - Street 2: | |
Mailing Address - City: | OWASSO |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74055-2500 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-376-2700 |
Mailing Address - Fax: | 918-376-2722 |
Practice Address - Street 1: | 12406 E 86TH ST N |
Practice Address - Street 2: | |
Practice Address - City: | OWASSO |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74055-2500 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-376-2700 |
Practice Address - Fax: | 918-376-2722 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-16 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 5499 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |