1710473897 NPI number — DAVID TOMA DDS, INC

Table of content: (NPI 1710473897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710473897 NPI number — DAVID TOMA DDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID TOMA 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:
6
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:
1710473897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 SWEETWATER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91977-5628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-964-0750
Provider Business Mailing Address Fax Number:
877-460-0720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 K ST NW STE 1104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-459-8450
Provider Business Practice Location Address Fax Number:
877-460-0720
Provider Enumeration Date:
07/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VELASQUEZ
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
877-459-8450

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DEN1001749 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018242192 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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