Provider Demographics
NPI:1447589452
Name:THOMAS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:THOMAS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:BOTHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-644-7697
Mailing Address - Street 1:12575 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0517
Mailing Address - Country:US
Mailing Address - Phone:503-644-7697
Mailing Address - Fax:503-626-4618
Practice Address - Street 1:12575 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0517
Practice Address - Country:US
Practice Address - Phone:503-644-7697
Practice Address - Fax:503-626-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental