Provider Demographics
NPI:1912113119
Name:DR THOMAS J. O'HARA
Entity Type:Organization
Organization Name:DR THOMAS J. O'HARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-340-1153
Mailing Address - Street 1:242 MUSTANG TRL
Mailing Address - Street 2:SUITE #9
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7515
Mailing Address - Country:US
Mailing Address - Phone:757-340-1153
Mailing Address - Fax:757-463-2647
Practice Address - Street 1:242 MUSTANG TRL
Practice Address - Street 2:SUITE #9
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7515
Practice Address - Country:US
Practice Address - Phone:757-340-1153
Practice Address - Fax:757-463-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA72431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty