Healthcare Provider Details

I. General information

NPI: 1063510287
Provider Name (Legal Business Name): SONY THOMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W DUARTE RD STE 1
ARCADIA CA
91007-7361
US

IV. Provider business mailing address

550 W DUARTE RD STE 1
ARCADIA CA
91007-7361
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-8889
  • Fax:
Mailing address:
  • Phone: 626-446-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberCA45333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: