Provider Demographics
NPI:1487796934
Name:THOMASES, MARK ROY (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROY
Last Name:THOMASES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:THOMASES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:21 ZELLER ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-469-3510
Mailing Address - Fax:
Practice Address - Street 1:1247A BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-566-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice