Provider Demographics
NPI:1730390477
Name:THOMASWMADDOCKSDDSAPC
Entity type:Organization
Organization Name:THOMASWMADDOCKSDDSAPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MADDOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-758-9400
Mailing Address - Street 1:77 S LA SENDA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6730
Mailing Address - Country:US
Mailing Address - Phone:949-499-1752
Mailing Address - Fax:949-499-1202
Practice Address - Street 1:1976 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5939
Practice Address - Country:US
Practice Address - Phone:760-758-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32352261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental