Provider Demographics
NPI:1528040912
Name:MITCHELL, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:MITCHELL
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 1:10001 NE 8TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4164
Mailing Address - Country:US
Mailing Address - Phone:425-454-1300
Mailing Address - Fax:425-454-0223
Practice Address - Street 1:10001 NE 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4164
Practice Address - Country:US
Practice Address - Phone:425-454-1300
Practice Address - Fax:425-454-0223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice