MEDICARE: THOMAS R. BALES 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	24429	CA

General Provider Information

NPI Number	:	1770688517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS R. BALES DDS INC

Provider Business Mailing Address
First Line	:	1713 NOVATO BLVD
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947
Country	:	US
Telephone Number	:	415-897-3141
Fax Number	:	415-898-3445

Provider Business Practice Location Address
First Line	:	1713 NOVATO BLVD
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947
Country	:	US
Telephone Number	:	415-897-3141
Fax Number	:	415-898-3445

Authorized Official
Title or Position	:	ORTHODONTIST/OWNER
Name	:	DR. THOMAS REED BALES
Credential	:	DDS
Telephone Number	:	415-897-3141

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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