Organization
THOMAS DENTAL OFFICE PC
Active
Other names
cornell thomas
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOROTHY J DEAVAULT (DENTAL ASSISTANT)
(314) 389-9990
Entity
Organization
Contact information
Practice address
3737 N KINGSHIGHWAY BLVD, SUITE 108, SAINT LOUIS, MO 63115-1736
(314) 389-7722
Mailing address
3737 N KINGSHIGHWAY BLVD, SUITE 108, SAINT LOUIS, MO 63115-1736
(314) 389-7722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12970
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002362
DORAL DENTAL
WI
05
—
400519328
—
MO
Enumeration date
06/27/2008
Last updated
06/27/2008
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