Provider Demographics
NPI:1124852629
Name:THOMAS, JASMINE (DDS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S GODDARD BLVD APT 463
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2040
Mailing Address - Country:US
Mailing Address - Phone:929-435-9310
Mailing Address - Fax:
Practice Address - Street 1:401 COMMERCE DR STE 104
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2714
Practice Address - Country:US
Practice Address - Phone:215-646-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0448191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice