Individual
KEVIN MAMOOTTIL THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 W ADAMS ST, PHOENIX, AZ 85003-2025
(602) 207-8528
Mailing address
1727 E PECOS RD APT 4079, GILBERT, AZ 85295-1879
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
063927
NY
122300000X
Dentist
Primary
D012634
AZ
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/02/2022
Last updated
03/10/2026
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