Provider Demographics
NPI:1346463478
Name:TOMKIE, GERARD ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:ANTHONY
Last Name:TOMKIE
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 1:80B VETERANS BLVD
Mailing Address - Street 2:ACOMA-CANONCITO-LAGUNA INDIAN
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5300
Mailing Address - Fax:
Practice Address - Street 1:80B VETERANS BLVD
Practice Address - Street 2:ACOMA-CANONCITO-LAGUNA INDIAN
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
NMH3451Medicaid