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General NPI Number Information
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NPI Number | 1578349395
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Entity Type | Organization
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Legal Business Name | JANNY THOMAS, RDHAP
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 14477 AMARGOSA RD STE 5
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City | VICTORVILLE
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State | CA
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Zip | 92392-2340
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Country | US
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Telephone | 760-490-4397
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Fax |
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Provider Business Mailing Address
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Address Line | 11668 FULTON CT
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City | VICTORVILLE
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State | CA
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Zip | 92392-0456
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Country | US
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Telephone | 760-490-4397
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Fax |
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Authorized Official
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Title or Position | RDHAP
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Name | JANNY THOMAS
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Credential |
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Telephone | 760-490-4397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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