Provider Demographics
NPI:1104979905
Name:DITCHEY, THOMAS KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEITH
Last Name:DITCHEY
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 1:740 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3627
Mailing Address - Country:US
Mailing Address - Phone:406-442-7980
Mailing Address - Fax:406-442-7989
Practice Address - Street 1:740 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3627
Practice Address - Country:US
Practice Address - Phone:406-442-7980
Practice Address - Fax:406-442-7989
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice