Provider Demographics
NPI:1487606950
Name:TOMAR, SCOTT LANCE (DMD, DRPH)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LANCE
Last Name:TOMAR
Suffix:
Gender:M
Credentials:DMD, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S PAULINA ST # MC621
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-413-7365
Mailing Address - Fax:312-413-9050
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-413-7365
Practice Address - Fax:312-413-9050
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0329031223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health