Individual
THOMAS KELLY LIVINGSTON MIRCHEL
Active
Individual
THOMAS KELLY LIVINGSTON MIRCHEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MD
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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