Provider Demographics
NPI:1548246044
Name:ELIAS, THOMAS GABRIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GABRIEL
Last Name:ELIAS
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 1:6043 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2160
Mailing Address - Country:US
Mailing Address - Phone:804-739-8287
Mailing Address - Fax:804-739-3934
Practice Address - Street 1:6043 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2160
Practice Address - Country:US
Practice Address - Phone:804-739-8287
Practice Address - Fax:804-739-3934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0006664OtherANTHEM INS
669561OtherUNITED CONCORDIA INS