Provider Demographics
NPI:1164589206
Name:TOWNSAN, THOMAS DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DALE
Last Name:TOWNSAN
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 1:860 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1916
Mailing Address - Country:US
Mailing Address - Phone:425-355-0515
Mailing Address - Fax:425-355-0515
Practice Address - Street 1:19514 64TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5105
Practice Address - Country:US
Practice Address - Phone:425-774-0111
Practice Address - Fax:425-775-5624
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000037421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice