Active NPI
Philip John Thomas, D.D.S.
- Pediatric Dentistry
- Longview, TX
National Provider Identifier
1104951284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 13954
- Practice address
- 5 Doctor Cir
Longview, TX 75605-5050 - Phone
- (903) 758-6406
- Fax
- (903) 758-8116
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 13954 | TX | Primary |
Addresses
Primary practice location
5 Doctor Cir
Longview, TX 75605-5050
Mailing address
5 Doctor Cir
Longview, TX 75605-5050
Phone (903) 758-6406
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0905552301 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13954 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104951284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 DOCTOR CIR",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055050",
"telephone_number": "903-758-6406",
"fax_number": "903-758-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 DOCTOR CIR",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055050",
"telephone_number": "903-758-6406",
"fax_number": "903-758-8116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "PHILIP",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "13954",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0905552301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.