Provider Demographics
NPI:1710075288
Name:RUMPH, THOMAS C (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:RUMPH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:C
Other - Last Name:RUMPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3210 WILCOX BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411
Mailing Address - Country:US
Mailing Address - Phone:423-622-4869
Mailing Address - Fax:
Practice Address - Street 1:3210 WILCOX BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-1071
Practice Address - Country:US
Practice Address - Phone:423-622-4869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4119DS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00940805AMedicaid
TN4652Medicaid