Provider Demographics
NPI:1558437350
Name:THOMALLA, FRANK T III (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:T
Last Name:THOMALLA
Suffix:III
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:PO BOX 453
Mailing Address - Street 2:3410 GEORGIA STREET
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353
Mailing Address - Country:US
Mailing Address - Phone:573-754-6307
Mailing Address - Fax:573-754-5135
Practice Address - Street 1:3410 GEORGIA STREET
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353
Practice Address - Country:US
Practice Address - Phone:573-754-6307
Practice Address - Fax:573-754-5135
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist