Provider Demographics
NPI:1457574394
Name:THOMAS, CAROLYN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15857 NORTHUP WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2536
Mailing Address - Country:US
Mailing Address - Phone:206-683-9106
Mailing Address - Fax:253-539-7538
Practice Address - Street 1:130 131ST ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4804
Practice Address - Country:US
Practice Address - Phone:253-539-7445
Practice Address - Fax:253-539-7538
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000064431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5050539Medicare ID - Type UnspecifiedDEPT SOCIAL HEALTH SERVIC