Provider Demographics
NPI:1629050653
Name:DODSON, THOMAS B (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:DODSON
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357134
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-543-5860
Mailing Address - Fax:206-685-7222
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 357134
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-5860
Practice Address - Fax:206-685-7222
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155481223S0112X
GA0109501223S0112X
CO78851223S0112X
CA346061223S0112X
WADE603864781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA015548OtherTUFTS HEALTH PLAN
MAX07675OtherBCBS MA
MAX20025Medicare ID - Type Unspecified
MA015548OtherTUFTS HEALTH PLAN