Provider Demographics
NPI:1770664385
Name:THOMAS F. TILSON, DDS, MS, PLLC
Entity Type:Organization
Organization Name:THOMAS F. TILSON, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:360-943-1910
Mailing Address - Street 1:1934 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4632
Mailing Address - Country:US
Mailing Address - Phone:360-943-1910
Mailing Address - Fax:360-943-6258
Practice Address - Street 1:1934 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4632
Practice Address - Country:US
Practice Address - Phone:360-943-1910
Practice Address - Fax:360-943-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000072351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty