Provider Demographics
NPI:1073953865
Name:RAWCLIFFE, THOMAS WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:RAWCLIFFE
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 1:401 ED SCHMIDT BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634
Mailing Address - Country:US
Mailing Address - Phone:512-846-2011
Mailing Address - Fax:512-846-2033
Practice Address - Street 1:1900 UNIVERSITY BLVD STE 180
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2313
Practice Address - Country:US
Practice Address - Phone:512-643-6104
Practice Address - Fax:512-843-4510
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011367Medicaid
CT004011136Medicaid