Provider Demographics
NPI:1932266020
Name:MICHAEL C. THOMAS, DMD, PC
Entity Type:Organization
Organization Name:MICHAEL C. THOMAS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-883-7409
Mailing Address - Street 1:2800 FOOTHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3768
Mailing Address - Country:US
Mailing Address - Phone:541-883-7409
Mailing Address - Fax:541-850-8672
Practice Address - Street 1:2800 FOOTHILLS BLVD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3768
Practice Address - Country:US
Practice Address - Phone:541-883-7409
Practice Address - Fax:541-850-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6822261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental