Provider Demographics
NPI:1235222951
Name:ROBERTS, THOMAS GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GLENN
Last Name:ROBERTS
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 1:100 W HARRISON ST
Mailing Address - Street 2:N. TOWER #150
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4116
Mailing Address - Country:US
Mailing Address - Phone:206-284-4412
Mailing Address - Fax:206-217-0195
Practice Address - Street 1:100 W HARRISON ST
Practice Address - Street 2:N. TOWER #150
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4116
Practice Address - Country:US
Practice Address - Phone:206-284-4412
Practice Address - Fax:206-217-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist