Provider Demographics
NPI:1952513616
Name:THURMAN, KARRIEM R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KARRIEM
Middle Name:R
Last Name:THURMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PAT BOOKER ROAD
Mailing Address - Street 2:STE 120
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-1101
Mailing Address - Country:US
Mailing Address - Phone:210-599-9900
Mailing Address - Fax:210-599-9504
Practice Address - Street 1:2101 PAT BOOKER ROAD
Practice Address - Street 2:STE 120
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-1101
Practice Address - Country:US
Practice Address - Phone:210-599-9900
Practice Address - Fax:210-599-9504
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384911223E0200X
NY051276-11223E0200X
TX259891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218232102Medicaid