Healthcare Provider Details

I. General information

NPI: 1861791915
Provider Name (Legal Business Name): ROSEMARY THOMAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 NE BEL RED RD STE 202
BELLEVUE WA
98007-3900
US

IV. Provider business mailing address

14655 NE BEL RED RD STE 202
BELLEVUE WA
98007-3900
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-7007
  • Fax: 425-747-7342
Mailing address:
  • Phone: 257-477-0074
  • Fax: 425-747-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number60843940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: