Provider Demographics
NPI:1760492854
Name:TOMITA, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:TOMITA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9750 COVINGTON CROSS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-341-7979
Mailing Address - Fax:702-341-9266
Practice Address - Street 1:9750 COVINGTON CROSS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-7042
Practice Address - Country:US
Practice Address - Phone:702-341-7979
Practice Address - Fax:702-341-9266
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist