Provider Demographics
NPI:1669701819
Name:TOMAZIN, CHAD ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANTHONY
Last Name:TOMAZIN
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 1:7697 WHITEGATE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5483
Mailing Address - Country:US
Mailing Address - Phone:951-333-1107
Mailing Address - Fax:951-888-2052
Practice Address - Street 1:7697 WHITEGATE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5483
Practice Address - Country:US
Practice Address - Phone:951-333-1107
Practice Address - Fax:951-888-2052
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587621223D0004X, 122300000X
TX275821223D0004X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist