Provider Demographics
NPI:1316099492
Name:NELSON, THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:NELSON
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 1:9750 NE 120TH PL
Mailing Address - Street 2:STE 7
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4282
Mailing Address - Country:US
Mailing Address - Phone:425-823-9421
Mailing Address - Fax:425-823-7969
Practice Address - Street 1:9750 NE 120TH PL
Practice Address - Street 2:STE 7
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4282
Practice Address - Country:US
Practice Address - Phone:425-823-9421
Practice Address - Fax:425-823-7969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist