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General NPI Number Information
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NPI Number | 1750422853
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Entity Type | Individual
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Provider Name | THOMAS PATRICK MACK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 63 BAY TREE LN
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City | LOS ALTOS
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State | CA
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Zip | 94022-4624
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Country | US
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Telephone | 650-941-6909
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Fax | 650-942-1839
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Provider Business Mailing Address
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Address Line | 63 BAY TREE LN
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City | LOS ALTOS
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State | CA
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Zip | 94022-4624
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Country | US
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Telephone | 650-941-6909
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Fax | 650-942-1839
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22246
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License Number State | CA
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