=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578686945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS TOMA DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3460 HIGHLAND AVE STE D
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-420-1100
-----------------------------------------------------
Fax | 619-420-1016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3460 HIGHLAND AVE STE D
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-420-1100
-----------------------------------------------------
Fax | 619-420-1016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 42431
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------