Provider Demographics
NPI:1528198769
Name:THOMAS, BRIAN W (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD, MS
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Other - First Name:
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Mailing Address - Street 1:2047 OSPREY LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4111
Mailing Address - Country:US
Mailing Address - Phone:813-948-9494
Mailing Address - Fax:813-948-2429
Practice Address - Street 1:2047 OSPREY LN
Practice Address - Street 2:SUITE D
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4111
Practice Address - Country:US
Practice Address - Phone:813-948-9494
Practice Address - Fax:813-948-2429
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics