Provider Demographics
NPI:1679668768
Name:LOBRANO, THOMAS E SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:LOBRANO
Suffix:SR
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:PO BOX 789
Mailing Address - Street 2:260 MAIN ST.
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-0789
Mailing Address - Country:US
Mailing Address - Phone:601-645-5388
Mailing Address - Fax:
Practice Address - Street 1:260 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4200
Practice Address - Country:US
Practice Address - Phone:601-645-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1842-791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00675784Medicaid
MS00064701Medicaid
LA1890383Medicaid