Provider Demographics
NPI:1952455479
Name:FORD, THOMAS F (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:FORD
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 1:3762 MISSION AVE
Mailing Address - Street 2:104
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-1438
Mailing Address - Country:US
Mailing Address - Phone:760-439-3400
Mailing Address - Fax:760-439-5848
Practice Address - Street 1:3762 MISSION AVE
Practice Address - Street 2:104
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-1438
Practice Address - Country:US
Practice Address - Phone:760-439-3400
Practice Address - Fax:760-439-5848
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice