Organization
DR TOM DENTAL OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADELINE TOM DDS (OWNER)
(909) 483-3431
Entity
Organization
Contact information
Practice address
6795 CARNELIAN ST, ALTA LOMA, CA 91701
(909) 483-3431
Mailing address
6795 CARNELIAN ST, ALTA LOMA, CA 91701
(909) 483-3431
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
43122
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B4312201
MEDICAL
CA
Enumeration date
11/09/2006
Last updated
08/10/2012
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