Provider Demographics
NPI:1396815890
Name:THOMAS, TIMOTHY PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
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 1:37799 PROFESSIONAL CTR DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-464-2664
Mailing Address - Fax:734-464-4778
Practice Address - Street 1:37799 PROFESSIONAL CTR DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-464-2664
Practice Address - Fax:734-464-4778
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist