Provider Demographics
NPI:1902210305
Name:THOMAS, KANDY (DDS)
Entity Type:Individual
Prefix:
First Name:KANDY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 COURT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1906
Mailing Address - Country:US
Mailing Address - Phone:641-217-8046
Mailing Address - Fax:641-217-8046
Practice Address - Street 1:1920 COURT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1906
Practice Address - Country:US
Practice Address - Phone:641-217-8046
Practice Address - Fax:641-217-8046
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice