Provider Demographics
NPI:1124100177
Name:THOMAS, PHILIP WINSTON (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WINSTON
Last Name:THOMAS
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 1:217 W MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4376
Mailing Address - Country:US
Mailing Address - Phone:919-782-3798
Mailing Address - Fax:919-782-4459
Practice Address - Street 1:217 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4376
Practice Address - Country:US
Practice Address - Phone:919-782-3798
Practice Address - Fax:919-782-4459
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998409Medicaid
NC8998409Medicaid