Provider Demographics
NPI:1831147230
Name:REDFERN, THOMAS WAYNE (DDS PS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAYNE
Last Name:REDFERN
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 1307
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-779-9770
Mailing Address - Fax:360-779-4061
Practice Address - Street 1:20307 NW VIKING AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-9770
Practice Address - Fax:360-779-4061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist