Provider Demographics
NPI:1962063792
Name:THOMAS, JOANNE JOHNSON (DMD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:JOHNSON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 EUCLID HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2024
Mailing Address - Country:US
Mailing Address - Phone:781-290-8994
Mailing Address - Fax:
Practice Address - Street 1:6175 SOM CENTER RD STE 235
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2966
Practice Address - Country:US
Practice Address - Phone:440-248-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist