Provider Demographics
NPI:1679531412
Name:WINGO, THOMAS H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:WINGO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:H
Other - Last Name:WINGO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS, LLC
Mailing Address - Street 1:1008 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3040
Mailing Address - Country:US
Mailing Address - Phone:985-542-6855
Mailing Address - Fax:985-542-6656
Practice Address - Street 1:1008 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3040
Practice Address - Country:US
Practice Address - Phone:985-542-6855
Practice Address - Fax:985-542-6656
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834831Medicaid