Provider Demographics
NPI:1932655685
Name:THOMAS, TREVOR JAMAL (DDS)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMAL
Last Name:THOMAS
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 1:5322 DEANE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043
Mailing Address - Country:US
Mailing Address - Phone:561-628-2359
Mailing Address - Fax:
Practice Address - Street 1:3150 CASE RD
Practice Address - Street 2:BUILDING C
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570
Practice Address - Country:US
Practice Address - Phone:951-345-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice