Provider Demographics
NPI:1790709368
Name:THOMAS, TINA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 US HIGHWAY 27 N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1200
Mailing Address - Country:US
Mailing Address - Phone:863-382-0888
Mailing Address - Fax:863-382-6199
Practice Address - Street 1:5935 US HIGHWAY 27 N
Practice Address - Street 2:SUITE 103
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1200
Practice Address - Country:US
Practice Address - Phone:863-382-0888
Practice Address - Fax:863-382-6199
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 141341223G0001X
FLDH 16635124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Not Answered124Q00000XDental ProvidersDental Hygienist