Healthcare Provider Details

I. General information

NPI: 1124852629
Provider Name (Legal Business Name): JASMINE THOMAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BREA BLVD STE B
BREA CA
92821-4001
US

IV. Provider business mailing address

330 N BREA BLVD STE B
BREA CA
92821-4001
US

V. Phone/Fax

Practice location:
  • Phone: 929-435-9310
  • Fax:
Mailing address:
  • Phone: 929-435-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS112887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: