Provider Demographics
NPI:1548645591
Name:THOMAS, BINSON (DDS)
Entity type:Individual
Prefix:
First Name:BINSON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5502
Mailing Address - Country:US
Mailing Address - Phone:916-452-2123
Mailing Address - Fax:
Practice Address - Street 1:9640 BRUCEVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5937
Practice Address - Country:US
Practice Address - Phone:916-686-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10304122300000X
CA101847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101847Medicaid