Provider Demographics
NPI:1609150747
Name:THOMA, FJORALBA (DMD)
Entity Type:Individual
Prefix:
First Name:FJORALBA
Middle Name:
Last Name:THOMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:12301 ACADEMY RD
Practice Address - Street 2:SUITE# 201-202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1927
Practice Address - Country:US
Practice Address - Phone:215-632-1244
Practice Address - Fax:215-632-8456
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist