Provider Demographics
NPI:1326249723
Name:TUTLAND THOMAS
Entity Type:Organization
Organization Name:TUTLAND THOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-821-2526
Mailing Address - Street 1:13126 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-821-2526
Mailing Address - Fax:425-820-9114
Practice Address - Street 1:13126 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-821-2526
Practice Address - Fax:425-820-9114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUTLAND THOMAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA93611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTIN