Provider Demographics
NPI:1033243423
Name:BIANCHI, THOMAS E (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BIANCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 DEER PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2355
Mailing Address - Country:US
Mailing Address - Phone:209-478-2252
Mailing Address - Fax:
Practice Address - Street 1:3427 DEER PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2355
Practice Address - Country:US
Practice Address - Phone:209-478-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics