Provider Demographics
NPI:1487760583
Name:IRWIN, THOMAS M JR (DMD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:IRWIN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866
Mailing Address - Country:US
Mailing Address - Phone:814-342-5367
Mailing Address - Fax:814-342-8044
Practice Address - Street 1:428 N SECOND STREET
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866
Practice Address - Country:US
Practice Address - Phone:814-342-5367
Practice Address - Fax:814-342-8044
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 023667L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167037OtherUNITED CONCORDIA
PA0009178490002Medicaid