Provider Demographics
NPI:1942344627
Name:PHELPS, THOMAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:PHELPS
Suffix:
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 1:3200 MOWRY AVE
Mailing Address - Street 2:C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1510
Mailing Address - Country:US
Mailing Address - Phone:510-793-6660
Mailing Address - Fax:510-793-6423
Practice Address - Street 1:3200 MOWRY AVE
Practice Address - Street 2:C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1510
Practice Address - Country:US
Practice Address - Phone:510-793-6660
Practice Address - Fax:510-793-6423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics