Provider Demographics
NPI:1417226150
Name:BABA, THOMAS LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:BABA
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 1:352 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2357
Mailing Address - Country:US
Mailing Address - Phone:949-376-2236
Mailing Address - Fax:760-723-1480
Practice Address - Street 1:352 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2357
Practice Address - Country:US
Practice Address - Phone:949-376-2236
Practice Address - Fax:760-723-1480
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADV033237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist