Provider Demographics
NPI:1376551812
Name:TOMA, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TOMA
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 1:645 SWEETWATER ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977
Mailing Address - Country:US
Mailing Address - Phone:619-464-0426
Mailing Address - Fax:619-464-7125
Practice Address - Street 1:645 SWEETWATER ROAD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977
Practice Address - Country:US
Practice Address - Phone:619-464-0426
Practice Address - Fax:619-464-7125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19550122300000X
CAD12011223D0004X
DCDEN10017491223D0004X
CA480421223G0001X
MADN2228193-A1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018242192Medicaid