Provider Demographics
NPI:1457573156
Name:THOMAS, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
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 1:1490 CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6250
Mailing Address - Country:US
Mailing Address - Phone:321-267-3304
Mailing Address - Fax:321-267-9119
Practice Address - Street 1:1490 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6250
Practice Address - Country:US
Practice Address - Phone:321-267-3304
Practice Address - Fax:321-267-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice