Provider Demographics
NPI:1235404492
Name:THOMAS A BASE DMD
Entity Type:Organization
Organization Name:THOMAS A BASE DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-256-2090
Mailing Address - Street 1:10420 NE WASCO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3928
Mailing Address - Country:US
Mailing Address - Phone:503-256-2090
Mailing Address - Fax:
Practice Address - Street 1:10420 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3928
Practice Address - Country:US
Practice Address - Phone:503-256-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty