Provider Demographics
NPI:1043507627
Name:SZUTZ, THOMAS RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RANDALL
Last Name:SZUTZ
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 1:401 KENILWORTH DR
Mailing Address - Street 2:SUITE 960
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3400
Mailing Address - Country:US
Mailing Address - Phone:707-789-9600
Mailing Address - Fax:707-789-9549
Practice Address - Street 1:401 KENILWORTH DR
Practice Address - Street 2:SUITE 960
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3400
Practice Address - Country:US
Practice Address - Phone:707-789-9600
Practice Address - Fax:707-789-9549
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist