Provider Demographics
NPI:1659334811
Name:ROLLINS, THOMAS EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:ROLLINS
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 1:2385 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6514
Mailing Address - Country:US
Mailing Address - Phone:440-842-6021
Mailing Address - Fax:
Practice Address - Street 1:20508 SOUTHGATE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2900
Practice Address - Country:US
Practice Address - Phone:216-663-2292
Practice Address - Fax:216-663-2294
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341940255034OtherCARESOURCE
OH765748Medicaid