Individual
DR. JOHN WILLAIM THOUSAND IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3 CYPRESS BRANCH WAY, PALM COAST, FL 32164-8409
(386) 445-4247
Mailing address
980 WINDWARD WAY, ST AUGUSTINE, FL 32080-6182
(303) 250-4091
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
00201869
CO
Other
Enumeration date
04/20/2015
Last updated
02/25/2016
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