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General NPI Number Information
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NPI Number | 1447630116
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Entity Type | Organization
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Legal Business Name | THOMAS HENRY DDS PS DBA CANYON ORTHODONTICS
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 5620 112TH ST E SUITE 255
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City | PUYALLUP
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State | WA
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Zip | 98373-3206
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Country | US
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Telephone | 253-256-4000
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Fax | 253-770-9638
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Provider Business Mailing Address
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Address Line | 5620 112TH ST E SUITE 255
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City | PUYALLUP
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State | WA
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Zip | 98373-3206
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Country | US
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Telephone | 253-256-4000
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Fax | 253-770-9638
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. THOMAS HENRY
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Credential | DDS
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Telephone | 253-256-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5432
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10731
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License Number State | WA
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