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NPI Code Detail

MEDICARE: DR. ADELINE TOM DDS

MEDICARE: DR. ADELINE TOM DDS
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
1122300000XDentist43122CA

General Provider Information

NPI Number : 1730505777
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADELINE TOM DDS
Provider Business Mailing Address
First Line : 6795 CARNELIAN ST
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-4556
Country : US
Telephone Number : 909-483-3431
Fax Number : 909-483-2052
Provider Business Practice Location Address
First Line : 6795 CARNELIAN ST
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-4556
Country : US
Telephone Number : 909-483-3431
Fax Number : 909-483-2052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2014
Last Update Date : 03/14/2014

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