Provider Demographics
NPI:1720107667
Name:THOMASON, JAMES C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:THOMASON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 S YELLOWSTONE HWY STE 2901
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2635
Mailing Address - Country:US
Mailing Address - Phone:208-356-3012
Mailing Address - Fax:208-359-9612
Practice Address - Street 1:859 S YELLOWSTONE HWY STE 2901
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2635
Practice Address - Country:US
Practice Address - Phone:208-356-3012
Practice Address - Fax:208-359-9612
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD33921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice