Provider Demographics
NPI:1932275245
Name:ADAMS, THOMAS OLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OLIN
Last Name:ADAMS
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 1:4224 HOUMA BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2935
Mailing Address - Country:US
Mailing Address - Phone:504-454-4224
Mailing Address - Fax:504-456-5122
Practice Address - Street 1:4224 HOUMA BLVD STE 224
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2935
Practice Address - Country:US
Practice Address - Phone:504-454-4224
Practice Address - Fax:504-456-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22631223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1822639Medicaid
LAT19782Medicare UPIN
LA58116Medicare ID - Type Unspecified