Provider Demographics
NPI:1669598413
Name:THOMAS, MARYANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 SOUTHERN ARTERY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7163
Mailing Address - Country:US
Mailing Address - Phone:617-471-4449
Mailing Address - Fax:617-657-0775
Practice Address - Street 1:875 SOUTHERN ARTERY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7163
Practice Address - Country:US
Practice Address - Phone:617-471-4449
Practice Address - Fax:617-657-0775
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist