MEDICARE: TREVOR THOMAS DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1639731888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREVOR THOMAS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	460 N MCKINLEY ST STE 101
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3405
Country	:	US
Telephone Number	:	951-531-9693
Fax Number	:	951-905-1704

Authorized Official
Title or Position	:	OWNER
Name	:	TREVOR J THOMAS
Credential	:	DDS
Telephone Number	:	951-531-9693

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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