Provider Demographics
NPI:1639494214
Name:DANIEL J THOMAS, DDS PERIODONTAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:DANIEL J THOMAS, DDS PERIODONTAL SPECIALISTS, PC
Other - Org Name:PERIODONTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-663-4867
Mailing Address - Street 1:3355 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-525-4867
Mailing Address - Fax:816-268-5873
Practice Address - Street 1:3355 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2368
Practice Address - Country:US
Practice Address - Phone:816-525-4867
Practice Address - Fax:816-268-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty