Provider Demographics
NPI:1417170309
Name:DE BRUIN, TOMAS GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:GERARD
Last Name:DE BRUIN
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 1:631 SIERRA ROSE DR STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2075
Mailing Address - Country:US
Mailing Address - Phone:775-826-1838
Mailing Address - Fax:775-826-1889
Practice Address - Street 1:631 SIERRA ROSE DR STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2075
Practice Address - Country:US
Practice Address - Phone:775-826-1838
Practice Address - Fax:775-826-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist