Provider Demographics
NPI:1912122870
Name:ANDERKVIST, TOMAS (DDS,INC)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:ANDERKVIST
Suffix:
Gender:M
Credentials:DDS,INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD STE 1112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4005
Mailing Address - Country:US
Mailing Address - Phone:310-208-4084
Mailing Address - Fax:310-208-3826
Practice Address - Street 1:10921 WILSHIRE BLVD STE 1112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4005
Practice Address - Country:US
Practice Address - Phone:310-208-4084
Practice Address - Fax:310-208-3826
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics