Healthcare Provider Details

I. General information

NPI: 1760102834
Provider Name (Legal Business Name): THOMAS CHANTHEA BILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W ROSECRANS AVE
COMPTON CA
90222-3821
US

IV. Provider business mailing address

1384 ROSE GARDEN LN
CUPERTINO CA
95014-5231
US

V. Phone/Fax

Practice location:
  • Phone: 310-604-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: