Provider Demographics
NPI:1053530063
Name:THOMAS, JOE CARTER (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:CARTER
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 1:515 W LEE AVE
Mailing Address - Street 2:P.O. BOX 663
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3115
Mailing Address - Country:US
Mailing Address - Phone:870-563-5211
Mailing Address - Fax:870-563-5212
Practice Address - Street 1:515 W LEE AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3115
Practice Address - Country:US
Practice Address - Phone:870-563-5211
Practice Address - Fax:870-563-5212
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice