Provider Demographics
NPI:1669450383
Name:WOLD, THOMAS E (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:WOLD
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 1:124 NW HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2918
Mailing Address - Country:US
Mailing Address - Phone:541-389-1301
Mailing Address - Fax:541-389-2958
Practice Address - Street 1:124 NW HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2918
Practice Address - Country:US
Practice Address - Phone:541-389-1301
Practice Address - Fax:541-389-2958
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice