Provider Demographics
NPI:1881864015
Name:THOMAS, BRYAN GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GEORGE
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 1:1099 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4541
Mailing Address - Country:US
Mailing Address - Phone:248-360-3700
Mailing Address - Fax:
Practice Address - Street 1:1099 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4541
Practice Address - Country:US
Practice Address - Phone:248-360-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist