Provider Demographics
NPI:1285792119
Name:POOMKUDY, THOMAS AUGUSTINE (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:AUGUSTINE
Last Name:POOMKUDY
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 1:24850 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4002
Mailing Address - Country:US
Mailing Address - Phone:516-488-1500
Mailing Address - Fax:
Practice Address - Street 1:24850 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4002
Practice Address - Country:US
Practice Address - Phone:516-488-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01819194Medicaid