Provider Demographics
NPI:1215050513
Name:TOM, SAMMY (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:
Last Name:TOM
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 1:6817 GENERAL HAIG ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-4028
Mailing Address - Country:US
Mailing Address - Phone:504-723-7665
Mailing Address - Fax:413-723-7665
Practice Address - Street 1:8131 ST. CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-304-6800
Practice Address - Fax:504-304-6599
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice