1114483609 NPI number — TOMA, PETROS & SIMHAIRY DDS INC.

Table of content: DR. ROBERT ANTHONY CARUSO JR. DDS,MS (NPI 1770671729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114483609 NPI number — TOMA, PETROS & SIMHAIRY DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOMA, PETROS & SIMHAIRY DDS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114483609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2654 JAMACHA RD STE 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92019-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-306-0412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2654 JAMACHA RD STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-306-0412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PETROS
Authorized Official First Name:
DHAFIR
Authorized Official Middle Name:
JALAL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-306-0412

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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