MEDICARE: TOMA&PETROS DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	47154	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47154	OTHER	CA	DENTIST

General Provider Information

NPI Number	:	1194885608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMA&PETROS DDS INC

Provider Business Mailing Address
First Line	:	3530 CAMINO DEL RIO N
Second Line	:	SUIT 109
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1743
Country	:	US
Telephone Number	:	619-283-2093
Fax Number	:	619-283-0803

Provider Business Practice Location Address
First Line	:	3530 CAMINO DEL RIO N
Second Line	:	SUIT 109
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1743
Country	:	US
Telephone Number	:	619-283-2093
Fax Number	:	619-283-0803

Authorized Official
Title or Position	:	DENTIST
Name	:	DHAFIR J PETROS
Credential	:	DDS
Telephone Number	:	619-283-2093

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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