Provider Demographics
NPI:1265423933
Name:THOMAS, TIMOTHY RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
Last Name:THOMAS
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 1:5120 VIRGINIA WAY
Mailing Address - Street 2:SUITE B-12
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7515
Mailing Address - Country:US
Mailing Address - Phone:615-373-0883
Mailing Address - Fax:
Practice Address - Street 1:5120 VIRGINIA WAY
Practice Address - Street 2:SUITE B-12
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7515
Practice Address - Country:US
Practice Address - Phone:615-373-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist