Provider Demographics
NPI:1669475661
Name:BALES, THOMAS REED (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:REED
Last Name:BALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1713 NOVATO BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3014
Mailing Address - Country:US
Mailing Address - Phone:415-897-3141
Mailing Address - Fax:415-898-3445
Practice Address - Street 1:1713 NOVATO BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3014
Practice Address - Country:US
Practice Address - Phone:415-897-3141
Practice Address - Fax:415-898-3445
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics