Provider Demographics
NPI:1437126919
Name:MARSDEN, THOMAS D (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:MARSDEN
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 1:2019 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3812
Mailing Address - Country:US
Mailing Address - Phone:325-655-8992
Mailing Address - Fax:325-942-9088
Practice Address - Street 1:2019 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3812
Practice Address - Country:US
Practice Address - Phone:325-655-8992
Practice Address - Fax:325-942-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752053696OtherTAX ID
TX0084154-01Medicaid
TX025963OtherAETNA ID