Provider Demographics
NPI:1912035536
Name:KATRICE L THOMAS DMD PC
Entity Type:Organization
Organization Name:KATRICE L THOMAS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-260-7757
Mailing Address - Street 1:3845 INTERSTATE CT STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5223
Mailing Address - Country:US
Mailing Address - Phone:334-260-7757
Mailing Address - Fax:334-260-8409
Practice Address - Street 1:3845 INTERSTATE CT STE 2
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5223
Practice Address - Country:US
Practice Address - Phone:334-260-7757
Practice Address - Fax:334-260-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty