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General NPI Number Information
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NPI Number | 1215105887
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Entity Type | Organization
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Legal Business Name | STANLEY TOM, A DENTAL CORPORATION
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 501 S GARFIELD AVE
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City | ALHAMBRA
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State | CA
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Zip | 91801-3840
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Country | US
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Telephone | 626-570-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 501 S GARFIELD AVE
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City | ALHAMBRA
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State | CA
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Zip | 91801-3840
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Country | US
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Telephone | 626-570-1818
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STANLEY T TOM
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Credential | DDS
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Telephone | 626-627-9127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 42589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41684
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46987
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License Number State | CA
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