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NPI Code Detail

MEDICARE: DR. THOMAS TERUMI OMOTO D.M.D

MEDICARE:  DR. THOMAS TERUMI OMOTO  D.M.D
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
11223S0112XOral and Maxillofacial Surgery (Dentist)31506CA

General Provider Information

NPI Number : 1407817208
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS TERUMI OMOTO D.M.D
Provider Business Mailing Address
First Line : 927 DEEP VALLEY DR
Second Line :
City : ROLLING HILLS ESTATES
State : CA
Zip : 90274-3836
Country : US
Telephone Number : 310-377-0929
Fax Number : 310-377-0794
Provider Business Practice Location Address
First Line : 927 DEEP VALLEY DR
Second Line :
City : ROLLING HILLS ESTATES
State : CA
Zip : 90274-3808
Country : US
Telephone Number : 310-377-0929
Fax Number : 310-377-0794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 07/08/2007

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