Provider Demographics
NPI:1831352822
Name:TWILLEY, THOMAS DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:TWILLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:DANIEL
Other - Last Name:TWILLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1061 BIG A RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6027
Mailing Address - Country:US
Mailing Address - Phone:706-886-1424
Mailing Address - Fax:706-282-4061
Practice Address - Street 1:1061 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6027
Practice Address - Country:US
Practice Address - Phone:706-886-1424
Practice Address - Fax:706-282-4061
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist