Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 2015040667 | MO |
NPI | 1639510027 |
---|---|
Provider Name | Dr. Sean Michael Thoms |
First Address | Saint Louis, MO 63105-2465 |
Second Address | Saint Louis, MO 63105-2465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2013 |
Last Update Date | 28/12/2016 |