Provider Demographics
NPI:1174620033
Name:ELLERHORST, THOMAS CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CRAIG
Last Name:ELLERHORST
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 1:2300 SUTTER ST
Mailing Address - Street 2:# 204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3037
Mailing Address - Country:US
Mailing Address - Phone:415-921-0434
Mailing Address - Fax:415-921-0439
Practice Address - Street 1:2300 SUTTER ST
Practice Address - Street 2:# 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3037
Practice Address - Country:US
Practice Address - Phone:415-921-0434
Practice Address - Fax:415-921-0439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice