Healthcare Provider Details

I. General information

NPI: 1780779181
Provider Name (Legal Business Name): R.THOMAS CAWRSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 RENTON CENTER WAY SW STE 62
RENTON WA
98055-2378
US

IV. Provider business mailing address

10236 RAINIER AVE S
SEATTLE WA
98178-2612
US

V. Phone/Fax

Practice location:
  • Phone: 425-255-5532
  • Fax: 425-255-1658
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3910
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: