Healthcare Provider Details

I. General information

NPI: 1891815510
Provider Name (Legal Business Name): THOMAS A FACTOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH AVE
SAN FRANCISCO CA
94132-2006
US

IV. Provider business mailing address

366 DOLAN AVE
MILL VALLEY CA
94941-3824
US

V. Phone/Fax

Practice location:
  • Phone: 415-584-2537
  • Fax:
Mailing address:
  • Phone: 415-380-8959
  • Fax: 415-584-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number263408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: