Healthcare Provider Details

I. General information

NPI: 1699129379
Provider Name (Legal Business Name): DAVID TOMA DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SWEETWATER RD
SPRING VALLEY CA
91977-5628
US

IV. Provider business mailing address

76 BEDFORD ST
LEXINGTON MA
02420-4646
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-0426
  • Fax: 619-464-7125
Mailing address:
  • Phone: 617-977-5460
  • Fax: 617-977-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDN19550
License Number StateMA

VIII. Authorized Official

Name: DAVID TOMA
Title or Position: OWNER
Credential: DDS
Phone: 617-977-5460