Healthcare Provider Details

I. General information

NPI: 1881588374
Provider Name (Legal Business Name): DEREK TOW DMD, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 815
BEVERLY HILLS CA
90211-3106
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 815
BEVERLY HILLS CA
90211-3106
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-6363
  • Fax:
Mailing address:
  • Phone: 310-657-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DEREK TOW
Title or Position: CEO/PRESIDENT
Credential: DMD, MD
Phone: 408-891-2103