Provider Demographics
NPI:1396726782
Name:AUYONG, THOMAS GAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GAIL
Last Name:AUYONG
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 1:724 N DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1062
Mailing Address - Country:US
Mailing Address - Phone:909-860-3011
Mailing Address - Fax:909-860-0442
Practice Address - Street 1:724 N DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1062
Practice Address - Country:US
Practice Address - Phone:909-860-3011
Practice Address - Fax:909-860-0442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282741223S0112X
HI21651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery