Provider Demographics
NPI:1548437262
Name:THOMAS, WESLEY DELAINE (DMD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:DELAINE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 15TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2936
Mailing Address - Country:US
Mailing Address - Phone:202-506-7916
Mailing Address - Fax:
Practice Address - Street 1:915 N STREET SE
Practice Address - Street 2:BLDG 175, 2ND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374
Practice Address - Country:US
Practice Address - Phone:202-433-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist