Provider Demographics
NPI:1578766036
Name:TOMS, KEVIN WADE (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WADE
Last Name:TOMS
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 1:9070 DEVLIN RD
Mailing Address - Street 2:#140
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1041
Mailing Address - Country:US
Mailing Address - Phone:703-495-3124
Mailing Address - Fax:
Practice Address - Street 1:9070 DEVLIN RD
Practice Address - Street 2:#140
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-1041
Practice Address - Country:US
Practice Address - Phone:703-495-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054846122300000X
VA04014114541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist