Provider Demographics
NPI:1881848034
Name:THOMAS W.REDFERN DDS
Entity Type:Organization
Organization Name:THOMAS W.REDFERN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-779-9770
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0117
Mailing Address - Country:US
Mailing Address - Phone:360-779-9770
Mailing Address - Fax:360-779-4061
Practice Address - Street 1:20307 VIKING AVE NW
Practice Address - Street 2:SUITE 201
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:360-779-9770
Practice Address - Fax:360-779-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty