Healthcare Provider Details

I. General information

NPI: 1922111871
Provider Name (Legal Business Name): LORENCE THOMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 PEBBLE BEACH DRIVE #106
CITRUS HEIGHTS CA
95610
US

IV. Provider business mailing address

7916 PEBBLE BEACH DRIVE #106
CITRUS HEIGHTS CA
95610
US

V. Phone/Fax

Practice location:
  • Phone: 916-966-2227
  • Fax: 916-966-2282
Mailing address:
  • Phone: 916-966-2227
  • Fax: 916-966-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDC034782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: