Provider Demographics
NPI:1609026558
Name:THOMAS, TONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
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 1:3829 LOCKHILL SELMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1762
Mailing Address - Country:US
Mailing Address - Phone:210-366-3606
Mailing Address - Fax:
Practice Address - Street 1:3829 LOCKHILL SELMA RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1762
Practice Address - Country:US
Practice Address - Phone:210-366-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50054197122300000X, 1223G0001X
TX348161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist