Provider Demographics
NPI:1184681462
Name:WALDRON, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:WALDRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8811 92ND ST S
Mailing Address - Street 2:STE 109
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4036
Mailing Address - Country:US
Mailing Address - Phone:651-768-8180
Mailing Address - Fax:651-768-8184
Practice Address - Street 1:8811 92ND ST S
Practice Address - Street 2:STE 109
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4036
Practice Address - Country:US
Practice Address - Phone:651-768-8180
Practice Address - Fax:651-768-8184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics