Provider Demographics
NPI:1205055704
Name:PARHAM, THOMAS RANDALL (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RANDALL
Last Name:PARHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 TANO DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9306
Mailing Address - Country:US
Mailing Address - Phone:386-676-0111
Mailing Address - Fax:
Practice Address - Street 1:1702 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-5416
Practice Address - Country:US
Practice Address - Phone:386-672-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist