Provider Demographics
NPI:1427158070
Name:WICKLIFFE, THOMAS JAMES (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:WICKLIFFE
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0700
Mailing Address - Country:US
Mailing Address - Phone:406-248-3303
Mailing Address - Fax:
Practice Address - Street 1:1690 RIMROCK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-248-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry