Provider Demographics
NPI:1033448055
Name:STILLWELL, THOMAS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:STILLWELL
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 1:899 CONGRESS PKWY N
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-1659
Mailing Address - Country:US
Mailing Address - Phone:423-744-0668
Mailing Address - Fax:423-744-0668
Practice Address - Street 1:899 CONGRESS PKWY N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1659
Practice Address - Country:US
Practice Address - Phone:423-744-0668
Practice Address - Fax:423-744-0668
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000070491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice