Provider Demographics
NPI:1881825933
Name:PARE, THOMAS NELSON III (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NELSON
Last Name:PARE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E BELTLINE AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7676
Mailing Address - Country:US
Mailing Address - Phone:616-207-1280
Mailing Address - Fax:
Practice Address - Street 1:2025 E BELTLINE AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7676
Practice Address - Country:US
Practice Address - Phone:616-207-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.4560 GD122300000X
MI2901600864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4650Medicaid