Provider Demographics
NPI:1144393406
Name:TOMAS, IKE ARTHUR W (DDS)
Entity Type:Individual
Prefix:
First Name:IKE ARTHUR
Middle Name:W
Last Name:TOMAS
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 1:2277 SWANSON AVENUE
Mailing Address - Street 2:STE E
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-680-6222
Mailing Address - Fax:928-680-6222
Practice Address - Street 1:1180 CALIMESA BLVD
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1509
Practice Address - Country:US
Practice Address - Phone:909-570-4087
Practice Address - Fax:909-570-4505
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4508122300000X
CA424321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist