Provider Demographics
NPI:1043486707
Name:SKARSHAUG, THOMAS NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NICHOLAS
Last Name:SKARSHAUG
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 1:18209 SR 410 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5146
Mailing Address - Country:US
Mailing Address - Phone:253-826-8800
Mailing Address - Fax:253-447-2203
Practice Address - Street 1:18209 SR 410 E
Practice Address - Street 2:SUITE 300
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-826-8800
Practice Address - Fax:253-447-2203
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000045461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice