Provider Demographics
NPI:1780840470
Name:BIGELOW, THOMAS ROBERT (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3013
Mailing Address - Country:US
Mailing Address - Phone:406-866-0550
Mailing Address - Fax:406-866-0360
Practice Address - Street 1:2503 6TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3013
Practice Address - Country:US
Practice Address - Phone:406-866-0550
Practice Address - Fax:406-866-0360
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice