Provider Demographics
NPI:1710913017
Name:POND, THOMAS DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:POND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29723 TROUTDALE SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7737
Mailing Address - Country:US
Mailing Address - Phone:303-670-1539
Mailing Address - Fax:303-670-1587
Practice Address - Street 1:29723 TROUTDALE SCENIC DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7737
Practice Address - Country:US
Practice Address - Phone:303-670-1539
Practice Address - Fax:303-670-1587
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice