Provider Demographics
NPI:1740200443
Name:THOMAS, PUTHEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PUTHEN
Middle Name:A
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 1:230 NW 76TH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6635
Mailing Address - Country:US
Mailing Address - Phone:352-333-0441
Mailing Address - Fax:352-333-0443
Practice Address - Street 1:230 NW 76TH DR
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6635
Practice Address - Country:US
Practice Address - Phone:352-333-0441
Practice Address - Fax:352-333-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 138761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice