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Individual
BLAIR MICOLE THOMAS
Active
Individual
BLAIR MICOLE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
ANO4005272179
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
164
OK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S2-135
NV
Other
Enumeration date
12/29/2008
Last updated
07/29/2021
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