Individual
KELLY R. THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
12575 SW 3RD ST, BEAVERTON, OR 97005-0517
(503) 644-7697
Mailing address
12575 SW 3RD ST, BEAVERTON, OR 97005-0517
(503) 644-7697
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6393
OR
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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