Provider Demographics
NPI:1063621415
Name:PLYMALE, THOMAS L (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:PLYMALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:T
Other - Middle Name:L
Other - Last Name:PLYMALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2812 SW MAPP RD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2722
Mailing Address - Country:US
Mailing Address - Phone:772-283-8350
Mailing Address - Fax:772-220-8750
Practice Address - Street 1:2812 SW MAPP RD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2722
Practice Address - Country:US
Practice Address - Phone:772-283-8350
Practice Address - Fax:772-220-8750
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice