Provider Demographics
NPI:1689778045
Name:THOMAS, MICHAEL DUANE (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUANE
Last Name:THOMAS
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 1:1610 JONES
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1732
Mailing Address - Country:US
Mailing Address - Phone:580-255-2771
Mailing Address - Fax:580-255-2789
Practice Address - Street 1:1610 JONES
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1732
Practice Address - Country:US
Practice Address - Phone:580-255-2771
Practice Address - Fax:580-255-2789
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist