Provider Demographics
NPI:1366056624
Name:GILLCRIST, THOMAS JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:GILLCRIST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER, 2D DENBN/NDC, PSC 20130
Mailing Address - Street 2:315 MCHUGH BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0130
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8749
Practice Address - Street 1:COMMANDING OFFICER, 2D DENBN/NDC, PSC 20130
Practice Address - Street 2:315 MCHUGH BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0130
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:910-451-8749
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist