Provider Demographics
NPI:1396953865
Name:THOMAS, BINU ABRAHAM (DDS)
Entity type:Individual
Prefix:MR
First Name:BINU
Middle Name:ABRAHAM
Last Name:THOMAS
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 1:9197 GREENBACK LANE
Mailing Address - Street 2:STE. C
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4792
Mailing Address - Country:US
Mailing Address - Phone:916-988-8890
Mailing Address - Fax:916-989-2187
Practice Address - Street 1:9197 GREENBACK LANE
Practice Address - Street 2:STE. C
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4792
Practice Address - Country:US
Practice Address - Phone:916-988-8890
Practice Address - Fax:916-989-2187
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD527851223G0001X
CA527851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice