Individual
KEVIN GEORGE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1101 N PROVIDENCE RD, COLUMBIA, MO 65203-4365
(573) 886-6741
Mailing address
1836 LACKLAND HILL PARKWAY, ST. LOUIS, MO 63146
(314) 872-1439
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2017017287
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017017287
MISSOURI DENTAL LICENSE
MO
Enumeration date
07/12/2017
Last updated
06/16/2018
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