Provider Demographics
NPI:1215105887
Name:STANLEY TOM, A DENTAL CORPORATION
Entity type:Organization
Organization Name:STANLEY TOM, A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-627-9127
Mailing Address - Street 1:501 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3840
Mailing Address - Country:US
Mailing Address - Phone:626-570-1818
Mailing Address - Fax:
Practice Address - Street 1:501 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3840
Practice Address - Country:US
Practice Address - Phone:626-570-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46987122300000X
CA42589122300000X
CA41684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100-857328OtherSELLER PERMIT
CA47923OtherBUSINESS LICENSE NUMBER
CAFAC64331OtherRADIATION MACHINE REG
CAF-01013OtherCERTIFICATE OF OCCUPANCY