Provider Demographics
NPI:1215589841
Name:THOMAS FAMILY DENTIST, LLC
Entity type:Organization
Organization Name:THOMAS FAMILY DENTIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-670-0699
Mailing Address - Street 1:1981 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5811
Mailing Address - Country:US
Mailing Address - Phone:302-697-1152
Mailing Address - Fax:
Practice Address - Street 1:1981 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5811
Practice Address - Country:US
Practice Address - Phone:302-697-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental