Provider Demographics
NPI:1720259088
Name:THOMAS, PRAMOD K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:K
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 1:445 E WALNUT ST.
Mailing Address - Street 2:#133
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5584
Mailing Address - Country:US
Mailing Address - Phone:972-238-7233
Mailing Address - Fax:972-238-8993
Practice Address - Street 1:445 WALNUT ST
Practice Address - Street 2:#133
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5649
Practice Address - Country:US
Practice Address - Phone:972-238-7233
Practice Address - Fax:972-238-8993
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193995101Medicaid