Provider Demographics
NPI:1821236993
Name:KNEZ, THOMAS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:KNEZ
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 1:306 DOLAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3824
Mailing Address - Country:US
Mailing Address - Phone:415-383-1733
Mailing Address - Fax:415-383-6598
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-3141
Practice Address - Fax:415-461-6252
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist