Provider Demographics
NPI:1497968648
Name:TOM, STEVEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:TOM
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 1:3200 MOWRY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 MOWRY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1510
Practice Address - Country:US
Practice Address - Phone:510-792-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice