Provider Demographics
NPI:1669563243
Name:THOMAS DMD & CUMBERBATCH DDS, P.A. DBA BAYTOWN GENTLE DENTAL CENTER
Entity type:Organization
Organization Name:THOMAS DMD & CUMBERBATCH DDS, P.A. DBA BAYTOWN GENTLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CREDEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-837-9122
Mailing Address - Street 1:3700 EMMET HUTTO BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1764
Mailing Address - Country:US
Mailing Address - Phone:281-837-9122
Mailing Address - Fax:281-837-6009
Practice Address - Street 1:3700 EMMET HUTTO BLVD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1764
Practice Address - Country:US
Practice Address - Phone:281-837-9122
Practice Address - Fax:281-837-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty