Provider Demographics
NPI:1790829679
Name:JEFFREY TOM DDS INC
Entity Type:Organization
Organization Name:JEFFREY TOM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FMD
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-568-5928
Mailing Address - Street 1:72415 PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-568-5928
Mailing Address - Fax:760-568-5192
Practice Address - Street 1:72415 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-568-5928
Practice Address - Fax:760-568-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty