Provider Demographics
NPI:1730142886
Name:MITCHELL, THOMAS W (DDS, PS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3712
Mailing Address - Country:US
Mailing Address - Phone:253-858-2560
Mailing Address - Fax:253-853-6392
Practice Address - Street 1:3220 UDDENBERG LN
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5128
Practice Address - Country:US
Practice Address - Phone:253-858-2560
Practice Address - Fax:253-853-6392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist