Provider Demographics
NPI:1912112681
Name:TOMKORIA, ANITA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:TOMKORIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E KATELLA AVE
Mailing Address - Street 2:STE O
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5008
Mailing Address - Country:US
Mailing Address - Phone:714-639-3200
Mailing Address - Fax:714-602-7648
Practice Address - Street 1:1500 E KATELLA AVE
Practice Address - Street 2:STE O
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5008
Practice Address - Country:US
Practice Address - Phone:714-639-3200
Practice Address - Fax:714-602-7648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist