Provider Demographics
NPI:1841336443
Name:DELOPEZ, THOMAS EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:DELOPEZ
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 1:210 JOHN KNOX RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6643
Mailing Address - Country:US
Mailing Address - Phone:850-386-5174
Mailing Address - Fax:
Practice Address - Street 1:210 JOHN KNOX RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6643
Practice Address - Country:US
Practice Address - Phone:850-386-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist