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General NPI Number Information
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NPI Number | 1689682767
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Entity Type | Individual
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Provider Name | THOMAS L. TATE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 CLIFF DR
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City | GRAHAM
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State | TX
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Zip | 76450-3327
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Country | US
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Telephone | 940-549-0372
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Fax | 940-549-3970
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Provider Business Mailing Address
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Address Line | 501 CLIFF DR
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City | GRAHAM
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State | TX
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Zip | 76450-3327
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Country | US
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Telephone | 940-549-0372
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Fax | 940-549-3970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12625
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License Number State | TX
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