Provider Demographics
NPI:1982722690
Name:THOMAS, MICHAEL CHANDI (DDS, MPH, MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHANDI
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS, MPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6495 NEW HAMPSHIRE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3200
Mailing Address - Country:US
Mailing Address - Phone:301-270-3334
Mailing Address - Fax:301-270-3336
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE STE 115
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3200
Practice Address - Country:US
Practice Address - Phone:301-270-3334
Practice Address - Fax:301-270-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD080661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice