Provider Demographics
NPI:1376625459
Name:THOMS, LISA MICHELLE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:THOMS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 NE BOTHELL WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-486-2715
Mailing Address - Fax:425-486-5782
Practice Address - Street 1:5701 NE BOTHELL WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-486-2715
Practice Address - Fax:425-486-5782
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics