Provider Demographics
NPI:1902828387
Name:THOMAS, NEIL WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WAYNE
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 1:1445 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-4264
Mailing Address - Country:US
Mailing Address - Phone:248-676-2146
Mailing Address - Fax:248-684-0218
Practice Address - Street 1:5841 WHITMORE LAKE RD
Practice Address - Street 2:SUITE D
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2470
Practice Address - Country:US
Practice Address - Phone:810-227-5136
Practice Address - Fax:810-227-5612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI105771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice