Provider Demographics
NPI:1639437973
Name:THOM MARKESON DENTISTRY, PS
Entity Type:Organization
Organization Name:THOM MARKESON DENTISTRY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARKESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-522-9054
Mailing Address - Street 1:9730 3RD AVE NE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2023
Mailing Address - Country:US
Mailing Address - Phone:206-522-9054
Mailing Address - Fax:206-522-1807
Practice Address - Street 1:9730 3RD AVE NE
Practice Address - Street 2:SUITE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2023
Practice Address - Country:US
Practice Address - Phone:206-522-9054
Practice Address - Fax:206-522-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60269439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty