Provider Demographics
NPI:1326896614
Name:THOMAS, MATHEW MICHAEL
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S HORNING RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8625
Mailing Address - Country:US
Mailing Address - Phone:614-266-5125
Mailing Address - Fax:
Practice Address - Street 1:4049 DAYTON XENIA RD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-1954
Practice Address - Country:US
Practice Address - Phone:937-429-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0275211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice