Provider Demographics
NPI:1558311894
Name:THOMAS, JEFFERY RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RAYMOND
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 1:2808 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7305
Mailing Address - Country:US
Mailing Address - Phone:252-633-1631
Mailing Address - Fax:252-633-3922
Practice Address - Street 1:2808 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-7305
Practice Address - Country:US
Practice Address - Phone:252-633-1631
Practice Address - Fax:252-633-3922
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC45421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998406Medicaid
NC8998406Medicaid
NC241300Medicare ID - Type Unspecified