Provider Demographics
NPI:1437204666
Name:RISBRUDT, THOMAS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:RISBRUDT
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 1:655 CAMINO DE LOS MARES
Mailing Address - Street 2:STE. 128
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2809
Mailing Address - Country:US
Mailing Address - Phone:949-496-0311
Mailing Address - Fax:949-496-8093
Practice Address - Street 1:655 CAMINO DE LOS MARES
Practice Address - Street 2:STE. 128
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2809
Practice Address - Country:US
Practice Address - Phone:949-496-0311
Practice Address - Fax:949-496-8093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics