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:206-616-7251
Practice Address - Street 1:6222 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
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:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603864781223S0112X
CO78851223S0112X
MA155481223S0112X
CA346061223S0112X
GA0109501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA015548OtherTUFTS HEALTH PLAN
WA2030378Medicaid
MAX07675OtherBCBS MA
MA015548OtherTUFTS HEALTH PLAN