Provider Demographics
NPI:1265543409
Name:STOLWORTHY, THOMAS LANCE (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LANCE
Last Name:STOLWORTHY
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 1:901 BOREN AVE
Mailing Address - Street 2:SUITE #1700
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-381-3055
Mailing Address - Fax:206-381-3054
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE #1700
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-381-3055
Practice Address - Fax:206-381-3054
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice