Provider Demographics
NPI:1295943595
Name:LANEY, THOMAS JOACHIM (DDS , MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOACHIM
Last Name:LANEY
Suffix:
Gender:M
Credentials:DDS , MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2410
Mailing Address - Country:US
Mailing Address - Phone:509-765-5141
Mailing Address - Fax:509-765-5891
Practice Address - Street 1:1308 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2410
Practice Address - Country:US
Practice Address - Phone:509-765-5141
Practice Address - Fax:509-765-5891
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056631223S0112X
WAMD00024468204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1035674Medicaid
WA141393OtherDLI
WA5005343Medicaid
WA1035674Medicaid
WATO2001Medicare UPIN