Provider Demographics
NPI:1316094949
Name:DEPPE, THOMAS DWIGHT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DWIGHT
Last Name:DEPPE
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 1:1200 S LAKE POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7125
Mailing Address - Country:US
Mailing Address - Phone:208-939-5855
Mailing Address - Fax:
Practice Address - Street 1:4411 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3113
Practice Address - Country:US
Practice Address - Phone:208-466-3597
Practice Address - Fax:208-466-4187
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-15851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice