Provider Demographics
NPI:1205114162
Name:FERNANDES, THOMAS LOWELL (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOWELL
Last Name:FERNANDES
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 1:105 W 8TH AVE STE 123C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-474-7495
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE STE 123C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-474-7498
Practice Address - Fax:509-227-7007
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD82791223G0001X
WADE608022241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice