Provider Demographics
NPI:1730241498
Name:TOMA, OMEED BUTRUS (DDS)
Entity type:Individual
Prefix:DR
First Name:OMEED
Middle Name:BUTRUS
Last Name:TOMA
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 1:3530 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1743
Mailing Address - Country:US
Mailing Address - Phone:619-283-2093
Mailing Address - Fax:
Practice Address - Street 1:3530 CAMINO DEL RIO N
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1743
Practice Address - Country:US
Practice Address - Phone:619-283-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice