Provider Demographics
NPI:1164494514
Name:TOMAICH, JOHN ALEX (MD,DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALEX
Last Name:TOMAICH
Suffix:
Gender:M
Credentials:MD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 B ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4610
Mailing Address - Country:US
Mailing Address - Phone:530-753-0550
Mailing Address - Fax:530-753-0440
Practice Address - Street 1:116 B ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4610
Practice Address - Country:US
Practice Address - Phone:530-753-0550
Practice Address - Fax:530-753-0440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01355ZMedicare ID - Type Unspecified