Provider Demographics
NPI:1891815510
Name:FACTOR, THOMAS A (DDS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:FACTOR
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 1:366 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:415-380-8959
Mailing Address - Fax:415-584-0542
Practice Address - Street 1:3100 19TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-2006
Practice Address - Country:US
Practice Address - Phone:415-584-2537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2634081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics