Provider Demographics
NPI:1952672511
Name:JACK B. THIGPEN, III, DMD, PA
Entity Type:Organization
Organization Name:JACK B. THIGPEN, III, DMD, PA
Other - Org Name:WEST COAST CENTER FOR JAW SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLBURN BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-926-5989
Mailing Address - Street 1:10850 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5117
Mailing Address - Country:US
Mailing Address - Phone:813-926-5989
Mailing Address - Fax:813-926-0790
Practice Address - Street 1:10850 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-926-5989
Practice Address - Fax:813-926-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty