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NPI Code Detail

MEDICARE: DR. THOMAS MICHAEL BOONE D.D.S.

MEDICARE: DR. THOMAS MICHAEL BOONE D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry34661CA

General Provider Information

NPI Number : 1124042460
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MICHAEL BOONE D.D.S.
Provider Business Mailing Address
First Line : PO BOX 1543
Second Line :
City : SUNSET BEACH
State : CA
Zip : 90742-1543
Country : US
Telephone Number : 714-606-9194
Fax Number : 310-327-9146
Provider Business Practice Location Address
First Line : 11702 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-3609
Country : US
Telephone Number : 714-898-5600
Fax Number : 800-535-9941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 05/14/2011

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