Provider Demographics
NPI:1104883750
Name:THOMAS, DEANNA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LEIGH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 WYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-9028
Mailing Address - Country:US
Mailing Address - Phone:724-962-7034
Mailing Address - Fax:
Practice Address - Street 1:3705 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3410
Practice Address - Country:US
Practice Address - Phone:724-347-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028983L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice