Provider Demographics
NPI:1255420048
Name:DOUTHIT, THOMAS L (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:DOUTHIT
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 1:5975 FM 78
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1003
Mailing Address - Country:US
Mailing Address - Phone:210-661-4212
Mailing Address - Fax:
Practice Address - Street 1:5975 FM 78
Practice Address - Street 2:SUITE 360
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1003
Practice Address - Country:US
Practice Address - Phone:210-661-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUNITED CONDORDIAOther551157