Provider Demographics
NPI:1407204340
Name:MASH, THOMAS KEATON (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEATON
Last Name:MASH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WILKESBORO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4218
Mailing Address - Country:US
Mailing Address - Phone:336-667-4143
Mailing Address - Fax:
Practice Address - Street 1:122 WILKESBORO AVE
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4218
Practice Address - Country:US
Practice Address - Phone:336-667-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice