Individual
DR. RANDOLPH P THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
108 S CENTRAL AVE, CHURCH HILL, TN 37642-3723
(423) 357-7111
(423) 357-1991
Mailing address
PO BOX 349, CHURCH HILL, TN 37642-0349
(423) 357-7111
(423) 357-1991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS003397
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007056
BLUECROSS BLUESHIELD TN
TN
Enumeration date
01/23/2007
Last updated
07/08/2007
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