Provider Demographics
NPI:1649780222
Name:THOMSON FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:THOMSON FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-910-3468
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-1023
Mailing Address - Country:US
Mailing Address - Phone:706-910-3468
Mailing Address - Fax:706-597-1535
Practice Address - Street 1:540 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2117
Practice Address - Country:US
Practice Address - Phone:706-910-3468
Practice Address - Fax:706-597-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015012261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental