Provider Demographics
NPI:1891766796
Name:BINGHAM, THOMAS SAWYER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAWYER
Last Name:BINGHAM
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 1:82D DENTAL SQUADRON
Mailing Address - Street 2:149 HART STREET, SUITE #4
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-4474
Mailing Address - Fax:
Practice Address - Street 1:82D DENTAL SQUADRON
Practice Address - Street 2:149 HART STREET, SUITE #4
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0130281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice