Provider Demographics
NPI:1871703835
Name:THOMAS, WILLIAM CLARK (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARK
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 SHILOH LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2730
Mailing Address - Country:US
Mailing Address - Phone:205-901-9447
Mailing Address - Fax:
Practice Address - Street 1:5346 STADIUM TRACE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4583
Practice Address - Country:US
Practice Address - Phone:205-982-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry