Provider Demographics
NPI:1124247747
Name:DAVIDSON, THOMAS HAROLD (DDS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HAROLD
Last Name:DAVIDSON
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 1:202 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3212
Mailing Address - Country:US
Mailing Address - Phone:419-281-0734
Mailing Address - Fax:419-281-0734
Practice Address - Street 1:202 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3212
Practice Address - Country:US
Practice Address - Phone:419-281-0734
Practice Address - Fax:419-281-0734
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist