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General NPI Number Information
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NPI Number | 1669701819
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Entity Type | Individual
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Provider Name | CHAD ANTHONY TOMAZIN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 7697 WHITEGATE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-5483
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Country | US
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Telephone | 951-333-1107
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Fax | 951-888-2052
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Provider Business Mailing Address
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Address Line | 7697 WHITEGATE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-5483
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Country | US
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Telephone | 951-333-1107
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Fax | 951-888-2052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 58762
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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 | 58762
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 27582
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27582
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License Number State | TX
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