Provider Demographics
NPI:1043393739
Name:TAHOE CITY DENTAL GROUP
Entity type:Organization
Organization Name:TAHOE CITY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER DDS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-583-0278
Mailing Address - Street 1:PO BOX 5129
Mailing Address - Street 2:140 MACKINAW ST
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145
Mailing Address - Country:US
Mailing Address - Phone:530-583-0278
Mailing Address - Fax:530-583-8660
Practice Address - Street 1:140 MACKINAW ST
Practice Address - Street 2:
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-583-0278
Practice Address - Fax:530-583-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25458122300000X
CA41219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty