Provider Demographics
NPI:1790895670
Name:THOMAS, GEALON A (DDS)
Entity Type:Individual
Prefix:
First Name:GEALON
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 1:111 PEACOCK CT
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5086
Mailing Address - Country:US
Mailing Address - Phone:865-573-0274
Mailing Address - Fax:865-577-0174
Practice Address - Street 1:111 PEACOCK CT
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5086
Practice Address - Country:US
Practice Address - Phone:865-573-0274
Practice Address - Fax:865-577-0174
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 4691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0076466OtherBCBS