Provider Demographics
NPI:1740517564
Name:ORME, THOMAS RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RYAN
Last Name:ORME
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 1:1400 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2430
Mailing Address - Country:US
Mailing Address - Phone:573-634-4909
Mailing Address - Fax:
Practice Address - Street 1:1400 SOUTHWEST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2430
Practice Address - Country:US
Practice Address - Phone:573-634-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025981122300000X
MO2013026080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025981OtherTX STATE BOARD OF DENTAL EXAMINERS LICENSE
MO2013026080OtherMISSOURI DENTAL BOARD