Provider Demographics
NPI:1073668083
Name:THOMAS, JEFFREY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:THOMAS
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 1:13720 ARAPAHO ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3824
Mailing Address - Country:US
Mailing Address - Phone:909-622-1261
Mailing Address - Fax:
Practice Address - Street 1:160 E ARTESIA ST
Practice Address - Street 2:SUITE 125
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2900
Practice Address - Country:US
Practice Address - Phone:909-622-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0389291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice