Provider Demographics
NPI:1699924381
Name:THOMAS, TIMOTHY CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHRISTOPHER
Last Name:THOMAS
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 1:306 WALNUT AVE
Mailing Address - Street 2:SUITE 38
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4978
Mailing Address - Country:US
Mailing Address - Phone:619-234-0864
Mailing Address - Fax:619-234-0871
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:SUITE #38
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4978
Practice Address - Country:US
Practice Address - Phone:619-234-0864
Practice Address - Fax:619-234-0871
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice