Provider Demographics
NPI:1538273420
Name:CONLON, THOMAS OLIVER (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OLIVER
Last Name:CONLON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12509 E MISSION AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1049
Mailing Address - Country:US
Mailing Address - Phone:509-928-6464
Mailing Address - Fax:509-924-8892
Practice Address - Street 1:12509 E MISSION AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1049
Practice Address - Country:US
Practice Address - Phone:509-928-6464
Practice Address - Fax:509-924-8892
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000037921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics