Healthcare Provider Details

I. General information

NPI: 1669701819
Provider Name (Legal Business Name): CHAD ANTHONY TOMAZIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7697 WHITEGATE AVE
RIVERSIDE CA
92506-5483
US

IV. Provider business mailing address

7697 WHITEGATE AVE
RIVERSIDE CA
92506-5483
US

V. Phone/Fax

Practice location:
  • Phone: 951-333-1107
  • Fax: 951-888-2052
Mailing address:
  • Phone: 951-333-1107
  • Fax: 951-888-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number58762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number58762
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number27582
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: