Provider Demographics
NPI:1790792521
Name:THOMAS, DOUGLAS EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EUGENE
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 1:7500 E PINNACLE PEAK RD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3406
Mailing Address - Country:US
Mailing Address - Phone:480-585-2824
Mailing Address - Fax:480-585-2391
Practice Address - Street 1:7500 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE A-100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3406
Practice Address - Country:US
Practice Address - Phone:480-585-2824
Practice Address - Fax:480-585-2391
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD51581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics