Provider Demographics
NPI:1962586982
Name:SCHWAB, TOMMY RAYMOUND (DMD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:RAYMOUND
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19143 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8936
Mailing Address - Country:US
Mailing Address - Phone:719-481-4744
Mailing Address - Fax:719-481-4744
Practice Address - Street 1:19143 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8936
Practice Address - Country:US
Practice Address - Phone:719-481-4744
Practice Address - Fax:719-481-4744
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD-1053971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO105097OtherDENTISTRY