Provider Demographics
NPI:1811959240
Name:THOMAS, PATRICK CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CHARLES
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 1:20 MOCK ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1429
Mailing Address - Country:US
Mailing Address - Phone:330-534-1155
Mailing Address - Fax:330-534-1150
Practice Address - Street 1:510 GYPSY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1349
Practice Address - Country:US
Practice Address - Phone:330-884-3058
Practice Address - Fax:330-884-5788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300152211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307644Medicaid