Provider Demographics
NPI:1083681266
Name:JETT, THOMAS HARRISON (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HARRISON
Last Name:JETT
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 1:950 ELMHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7402
Mailing Address - Country:US
Mailing Address - Phone:785-827-4401
Mailing Address - Fax:785-827-1560
Practice Address - Street 1:950 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7402
Practice Address - Country:US
Practice Address - Phone:785-827-4401
Practice Address - Fax:785-827-1560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice