Dominique Danielle Thomas, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30-026421 Issued in OH

Practice address

1221 Ridgewood Dr Ste B
Bowling Green, OH 43402-2785

Phone

(419) 352-2593

Fax

(844) 224-3880

NPI assigned

Apr 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bowling Green Pediatric Dental Group Inc

  • Pediatric Dentistry
  • Bowling Green, OH
  • NPI 1477611333
  NPD (past)
• Precision Pediatric Dental Bowling Green LLC

  • Dentist
  • Bowling Green, OH
  • NPI 1376994731

  Pediatric Dentistry

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1396242012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 RIDGEWOOD DR STE B",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022785",
            "telephone_number": "419-352-2593",
            "fax_number": "844-224-3880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 RIDGEWOOD DR STE B",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022785",
            "telephone_number": "419-352-2593",
            "fax_number": "844-224-3880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436142595",
            "country_code": "US",
            "telephone_number": "419-383-3504",
            "fax_number": "419-383-6127",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 N Blanchard St Ste 122",
            "address_purpose": "LOCATION",
            "city": "Findlay",
            "state": "OH",
            "postal_code": "458404509",
            "country_code": "US",
            "telephone_number": "419-241-6215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "DOMINIQUE",
        "middle_name": "DANIELLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-09",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30-026421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neil Crawford Thompson, ATC
• Jessica Tiderman, DEM
• Carla Sue Tiell
• Logan Tiell

• All providers in Bowling Green, OH
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.