Provider Demographics
NPI:1275617367
Name:DWYER, THOMAS GEORGE
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:DWYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SUNRISE AVENUE
Mailing Address - Street 2:#110
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4549
Mailing Address - Country:US
Mailing Address - Phone:916-784-3993
Mailing Address - Fax:916-784-3916
Practice Address - Street 1:730 SUNRISE AVENUE
Practice Address - Street 2:#110
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4549
Practice Address - Country:US
Practice Address - Phone:916-784-3993
Practice Address - Fax:916-784-3916
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics