Provider Demographics
NPI:1760976997
Name:FOW, THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FOW
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 1:2217 W HAPPY VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-1604
Mailing Address - Country:US
Mailing Address - Phone:623-581-7031
Mailing Address - Fax:
Practice Address - Street 1:2217 W HAPPY VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-1604
Practice Address - Country:US
Practice Address - Phone:623-581-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0100651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice