Healthcare Provider Details

I. General information

NPI: 1861983090
Provider Name (Legal Business Name): TOMA, PETROS & EVANS DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 4TH AVE STE 300
SAN DIEGO CA
92101-2381
US

IV. Provider business mailing address

1901 4TH AVE STE 300
SAN DIEGO CA
92101-2381
US

V. Phone/Fax

Practice location:
  • Phone: 619-236-7959
  • Fax: 619-236-8943
Mailing address:
  • Phone: 619-236-7959
  • Fax: 619-236-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. OMEED B TOMA
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 619-236-7959