Healthcare Provider Details

I. General information

NPI: 1427495373
Provider Name (Legal Business Name): THOMAS MATTHEW KAISER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2013
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 GRAND AVE SUITE 200
OAKLAND CA
94610-4724
US

IV. Provider business mailing address

298 GRAND AVE SUITE 200
OAKLAND CA
94610-4724
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5251
  • Fax: 804-675-5952
Mailing address:
  • Phone: 804-675-5251
  • Fax: 804-675-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: