Provider Demographics
NPI:1124265640
Name:DR. ROBERT R. THOUSAND III P.A.
Entity type:Organization
Organization Name:DR. ROBERT R. THOUSAND III P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOUSAND
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-797-3044
Mailing Address - Street 1:10 SAINT JOHNS MEDICAL PK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5202
Mailing Address - Country:US
Mailing Address - Phone:904-797-3044
Mailing Address - Fax:904-797-3045
Practice Address - Street 1:10 SAINT JOHNS MEDICAL PK DR
Practice Address - Street 2:SUITE C
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5202
Practice Address - Country:US
Practice Address - Phone:904-797-3044
Practice Address - Fax:904-797-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 146711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty