Provider Demographics
NPI:1851311732
Name:TOM, ALEX W (DDS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:W
Last Name:TOM
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 1:14517 S BASCOM AVE
Mailing Address - Street 2:#C
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2003
Mailing Address - Country:US
Mailing Address - Phone:408-356-8101
Mailing Address - Fax:408-356-3831
Practice Address - Street 1:14517 S BASCOM AVE
Practice Address - Street 2:#C
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2003
Practice Address - Country:US
Practice Address - Phone:408-356-8101
Practice Address - Fax:408-356-3831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics