Provider Demographics
NPI:1700422458
Name:THOMAS DENTAL ACQUISITIONS, LLC
Entity Type:Organization
Organization Name:THOMAS DENTAL ACQUISITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-246-0260
Mailing Address - Street 1:6709 WHITE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-2503
Mailing Address - Country:US
Mailing Address - Phone:864-246-0260
Mailing Address - Fax:864-484-9449
Practice Address - Street 1:6709 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-2503
Practice Address - Country:US
Practice Address - Phone:864-246-0260
Practice Address - Fax:864-484-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30869Medicaid