# DR TOM DENTAL OFFICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851461354
- **Authorized official:** DR. ADELINE TOM DDS (OWNER)
- **Authorized official phone:** (909) 483-3431

## Contact information

- **Practice address:** 6795 CARNELIAN ST, ALTA LOMA, CA 91701
- **Practice address phone:** (909) 483-3431
- **Mailing address:** 6795 CARNELIAN ST, ALTA LOMA, CA 91701
- **Mailing address phone:** (909) 483-3431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 43122 | CA | Yes |

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 08/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | B4312201 | MEDICAL | CA |