Provider Demographics
NPI:1205957644
Name:THOMAS M SKAFIDAS DMD PC
Entity type:Organization
Organization Name:THOMAS M SKAFIDAS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKAFIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-261-2811
Mailing Address - Street 1:3091 MAPLE DRIVE NE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-261-2811
Mailing Address - Fax:404-261-1957
Practice Address - Street 1:3091 MAPLE DRIVE NE
Practice Address - Street 2:SUITE 114
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-261-2811
Practice Address - Fax:404-261-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty