1346346848 NPI number — JESSE M. THOMAS, D.D.S., PA

Table of content: (NPI 1346346848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346346848 NPI number — JESSE M. THOMAS, D.D.S., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSE M. THOMAS, D.D.S., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346346848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 SKYLINE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-424-7690
Provider Business Mailing Address Fax Number:
731-423-9167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 SKYLINE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-424-7690
Provider Business Practice Location Address Fax Number:
731-423-9167
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
731-424-7690

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS 1642 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223X0400X , with the licence number: 146 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)