Provider Demographics
NPI:1710473897
Name:DAVID TOMA DDS, INC
Entity Type:Organization
Organization Name:DAVID TOMA DDS, INC
Other - Org Name:KIDS DENTAL ANESTHESIA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:877-459-8450
Mailing Address - Street 1:645 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5628
Mailing Address - Country:US
Mailing Address - Phone:619-964-0750
Mailing Address - Fax:877-460-0720
Practice Address - Street 1:1800 K ST NW STE 1104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2235
Practice Address - Country:US
Practice Address - Phone:877-459-8450
Practice Address - Fax:877-460-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10017491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018242192Medicaid