Provider Demographics
NPI:1891894978
Name:THOMAS., EDWIN MICHAEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MICHAEL
Last Name:THOMAS.
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 WASHINGTON ST
Mailing Address - Street 2:P.O. BOX 2049
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2417
Mailing Address - Country:US
Mailing Address - Phone:781-878-2190
Mailing Address - Fax:781-878-3011
Practice Address - Street 1:477 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2417
Practice Address - Country:US
Practice Address - Phone:781-878-2190
Practice Address - Fax:781-878-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043090133OtherTAX ID #