Provider Demographics
NPI:1053673491
Name:PATRICK B TOMS DMD PC
Entity Type:Organization
Organization Name:PATRICK B TOMS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:TOMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-536-4471
Mailing Address - Street 1:590 SOUTH ENOTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2433
Mailing Address - Country:US
Mailing Address - Phone:770-536-4471
Mailing Address - Fax:770-534-2174
Practice Address - Street 1:590 SOUTH ENOTA DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2433
Practice Address - Country:US
Practice Address - Phone:770-536-4471
Practice Address - Fax:770-534-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011574122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty