Provider Demographics
NPI:1023846771
Name:TOMOR, RIELY (DMD)
Entity type:Individual
Prefix:DR
First Name:RIELY
Middle Name:
Last Name:TOMOR
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 1:207 BOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1574
Mailing Address - Country:US
Mailing Address - Phone:330-906-3634
Mailing Address - Fax:
Practice Address - Street 1:2535 LANDMARK DR STE 104
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3930
Practice Address - Country:US
Practice Address - Phone:727-791-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist