Provider Demographics
NPI:1598992836
Name:THOMAS, JONATHAN MAC (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MAC
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:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-0869
Mailing Address - Country:US
Mailing Address - Phone:808-879-1944
Mailing Address - Fax:808-874-6187
Practice Address - Street 1:1280 S KIHEI RD
Practice Address - Street 2:SUITE 209
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8240
Practice Address - Country:US
Practice Address - Phone:808-879-1944
Practice Address - Fax:808-874-6187
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-23661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice