Provider Demographics
NPI:1528079647
Name:POKSAY, THOMAS J (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:POKSAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 IGNACIO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6036
Mailing Address - Country:US
Mailing Address - Phone:415-883-0588
Mailing Address - Fax:415-883-0591
Practice Address - Street 1:330 IGNACIO BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6036
Practice Address - Country:US
Practice Address - Phone:415-883-0588
Practice Address - Fax:415-883-0591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA637324OtherUNITED CONCORDIA INS.