Provider Demographics
NPI:1225247919
Name:THOMAS E. LEQUIA 2ND ROBERT L. HILL, D.D.S.
Entity Type:Organization
Organization Name:THOMAS E. LEQUIA 2ND ROBERT L. HILL, D.D.S.
Other - Org Name:THOMAS E. LEQUIA AND JOHN L. JULIUS DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OWNER, PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEQUIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-384-1202
Mailing Address - Street 1:2800 PARK AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3375
Mailing Address - Country:US
Mailing Address - Phone:209-384-1202
Mailing Address - Fax:209-383-3895
Practice Address - Street 1:2800 PARK AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-384-1202
Practice Address - Fax:209-383-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402631223G0001X
CA332091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA831704Medicare UPIN