Provider Demographics
NPI:1255412649
Name:THOMAS, CARLA (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2322
Mailing Address - Country:US
Mailing Address - Phone:310-674-3232
Mailing Address - Fax:310-674-7040
Practice Address - Street 1:3300 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2322
Practice Address - Country:US
Practice Address - Phone:310-674-3232
Practice Address - Fax:310-674-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice