Provider Demographics
NPI:1770284705
Name:THOMAS GRASS DMD PLLC
Entity type:Organization
Organization Name:THOMAS GRASS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-702-3080
Mailing Address - Street 1:306 KASH DERRICK DR
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-2885
Mailing Address - Country:US
Mailing Address - Phone:503-702-3080
Mailing Address - Fax:
Practice Address - Street 1:331 W HWY 6 STE D
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5584
Practice Address - Country:US
Practice Address - Phone:254-772-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental