Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D010606 | AZ |
N | 1223D0001X | Dental Public Health | D1096 | SD |
NPI | 1386063378 |
---|---|
Provider Name | Dr. Nick Thome |
First Address | Wessington Springs, SD 57382-2167 |
Second Address | Marana, AZ 85653-7008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 18/05/2020 |