Provider Demographics
NPI:1942377106
Name:MAR, TOMSON P (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMSON
Middle Name:P
Last Name:MAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:P
Other - Last Name:MAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:318-6TH AVE SOUTH
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2730
Mailing Address - Country:US
Mailing Address - Phone:206-622-3840
Mailing Address - Fax:
Practice Address - Street 1:318-6TH AVE SOUTH
Practice Address - Street 2:SUITE #108
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2730
Practice Address - Country:US
Practice Address - Phone:206-622-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000055941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00005594OtherDENTAL LICENSE NUMBER
WADE00005594OtherDENTAL LICENSE NUMBER