Provider Demographics
NPI:1427495373
Name:KAISER, THOMAS MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MATTHEW
Last Name:KAISER
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 1:298 GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4724
Mailing Address - Country:US
Mailing Address - Phone:804-675-5251
Mailing Address - Fax:804-675-5952
Practice Address - Street 1:298 GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4724
Practice Address - Country:US
Practice Address - Phone:804-675-5251
Practice Address - Fax:804-675-5952
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice