Provider Demographics
NPI:1942441548
Name:DONALD S. TOM, D.M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DONALD S. TOM, D.M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-383-2363
Mailing Address - Street 1:5051 VERDUGO WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8680
Mailing Address - Country:US
Mailing Address - Phone:805-383-2363
Mailing Address - Fax:805-383-2712
Practice Address - Street 1:5051 VERDUGO WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8680
Practice Address - Country:US
Practice Address - Phone:805-383-2363
Practice Address - Fax:805-383-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty