Provider Demographics
NPI:1942414461
Name:INMAN, THOMAS G (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:INMAN
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 1:513 N WILLIAMS
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-1514
Mailing Address - Country:US
Mailing Address - Phone:870-552-3500
Mailing Address - Fax:870-552-3961
Practice Address - Street 1:513 N WILLIAMS
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:AR
Practice Address - Zip Code:72024-1514
Practice Address - Country:US
Practice Address - Phone:870-552-3500
Practice Address - Fax:870-552-3961
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56567OtherBLUE CROSS BLUE SHIELD
AR117097608Medicaid