Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12012667A | IN |
NPI | 1073929832 |
---|---|
Provider Name | Dr. Tyler Jeffrey Thomas |
First Address | Carmel, IN 46032-8757 |
Second Address | Carmel, IN 46032-2971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 17/03/2018 |