Provider Demographics
NPI:1861480907
Name:PINK, THOMAS JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:PINK
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 1:7270 FORESTVIEW LN N
Mailing Address - Street 2:#250
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5546
Mailing Address - Country:US
Mailing Address - Phone:763-424-9202
Mailing Address - Fax:763-424-9399
Practice Address - Street 1:7270 FORESTVIEW LN N
Practice Address - Street 2:#250
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5546
Practice Address - Country:US
Practice Address - Phone:763-424-9202
Practice Address - Fax:763-424-9399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist