Individual
THOMAS KELLY LIVINGSTON MIRCHEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MD
Contact information
Practice address
8101 NE PARKWAY DR STE F2, VANCOUVER, WA 98662-2434
(360) 882-4000
Mailing address
292 RIDGEWOOD DR, AMHERST, NY 14226-4942
(360) 901-1066
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11591
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DE61251169
WA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MD210269
OR
Other
Enumeration date
04/03/2016
Last updated
05/26/2022
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