Provider Demographics
NPI:1598846842
Name:TEETS, THOMAS GRAFTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GRAFTON
Last Name:TEETS
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 1:2628 EXECUTIVE PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3717
Mailing Address - Country:US
Mailing Address - Phone:228-388-7844
Mailing Address - Fax:228-388-7836
Practice Address - Street 1:2628 EXECUTIVE PL
Practice Address - Street 2:SUITE C
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3717
Practice Address - Country:US
Practice Address - Phone:228-388-7844
Practice Address - Fax:228-388-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2984-971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
720581OtherUNITED CONCORDIA