1306183736 NPI number — MARC D. THOMAS DDS, PC

Table of content: DR. CHRISTINE PREETI CHELLADURAI D.O. (NPI 1629396650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306183736 NPI number — MARC D. THOMAS DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARC D. THOMAS DDS, PC
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:
6
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:
1306183736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19551 HESS RD UNIT 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-841-7900
Provider Business Mailing Address Fax Number:
303-841-1650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19551 HESS RD UNIT 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-841-7900
Provider Business Practice Location Address Fax Number:
303-841-1650
Provider Enumeration Date:
01/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
MARC
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
303-841-7900

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  10771 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 46455035 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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