Provider Demographics
NPI:1619042553
Name:THOMAS, PHIL J (DDS)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:J
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 1:1411 J F KENNEDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3693
Mailing Address - Country:US
Mailing Address - Phone:402-291-3535
Mailing Address - Fax:402-291-0760
Practice Address - Street 1:1411 J F KENNEDY DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3693
Practice Address - Country:US
Practice Address - Phone:402-291-3535
Practice Address - Fax:402-291-0760
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice