Provider Demographics
NPI:1841433695
Name:DAVID TOMA DDS, INC.
Entity type:Organization
Organization Name:DAVID TOMA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-964-0750
Mailing Address - Street 1:10783 JAMACHA BLVD
Mailing Address - Street 2:8
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1842
Mailing Address - Country:US
Mailing Address - Phone:619-667-1088
Mailing Address - Fax:
Practice Address - Street 1:7040 BROADWAY
Practice Address - Street 2:A27
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1406
Practice Address - Country:US
Practice Address - Phone:619-667-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID TOMA DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty