Provider Demographics
NPI:1558448191
Name:THOMAS, FRED RICK (DMD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:RICK
Last Name:THOMAS
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 1:216 SW 156TH ST
Mailing Address - Street 2:SUITE #B-1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2566
Mailing Address - Country:US
Mailing Address - Phone:206-246-0831
Mailing Address - Fax:
Practice Address - Street 1:216 SW 156TH ST
Practice Address - Street 2:SUITE #B-1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166-2566
Practice Address - Country:US
Practice Address - Phone:206-246-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist