Provider Demographics
NPI:1053475806
Name:HOM, DICK MAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DICK
Middle Name:MAH
Last Name:HOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1925 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519
Mailing Address - Country:US
Mailing Address - Phone:925-676-1440
Mailing Address - Fax:925-676-0313
Practice Address - Street 1:1925 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-676-1440
Practice Address - Fax:925-676-0313
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0283291223S0112X
OH300162061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery