Provider Demographics
NPI:1154407591
Name:THAMES, ALLYN M III (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ALLYN
Middle Name:M
Last Name:THAMES
Suffix:III
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6622
Mailing Address - Country:US
Mailing Address - Phone:334-501-7000
Mailing Address - Fax:334-501-7062
Practice Address - Street 1:719 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6622
Practice Address - Country:US
Practice Address - Phone:334-501-7000
Practice Address - Fax:334-501-7062
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL53501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1899210OtherUNITED CONCORDIA
ALAL5350OtherAL LICENSE NUMBER
AL51537178OtherBCBS OF AL PROV NUMBER
ALAL5350OtherAL LICENSE NUMBER
AL51537178OtherBCBS OF AL PROV NUMBER