Organization
BRENT THOMAS DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BRENT THOMAS DMD (DENTIST)
(601) 638-2361
Entity
Organization
Contact information
Practice address
1805 MISSION 66, VICKSBURG, MS 39180-3709
(601) 638-2361
(601) 634-0864
Mailing address
1805 MISSION 66, VICKSBURG, MS 39180-3709
(601) 638-2361
(601) 634-0864
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
195381
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649492695
NPI INDIVIDUAL
MS
Enumeration date
10/31/2012
Last updated
10/31/2012
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