Provider Demographics
NPI:1720280290
Name:THOMAS, FARA (DDS)
Entity Type:Individual
Prefix:
First Name:FARA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 ALTA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8723
Mailing Address - Country:US
Mailing Address - Phone:702-313-2300
Mailing Address - Fax:702-309-4307
Practice Address - Street 1:10080 ALTA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8723
Practice Address - Country:US
Practice Address - Phone:702-313-2300
Practice Address - Fax:702-309-4307
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice