Healthcare Provider Details

I. General information

NPI: 1053673491
Provider Name (Legal Business Name): PATRICK B TOMS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 SOUTH ENOTA DRIVE
GAINESVILLE GA
30501-2433
US

IV. Provider business mailing address

590 SOUTH ENOTA DRIVE
GAINESVILLE GA
30501-2433
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-4471
  • Fax: 770-534-2174
Mailing address:
  • Phone: 770-536-4471
  • Fax: 770-534-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN011574
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK B TOMS
Title or Position: OWNER
Credential: DMD
Phone: 770-536-4471