MEDICARE: DR. MARIA MERCEDES DE THOMAS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	1965	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41904	OTHER	PR	TRIPLE-S, INC.

General Provider Information

NPI Number	:	1003811910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA MERCEDES DE THOMAS D.M.D.

Provider Business Mailing Address
First Line	:	CALLE DIAMANTE #A-20 GOLDEN GATE, CAPARRA
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3413
Country	:	US
Telephone Number	:	787-245-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE DIAMANTE #A-20 GOLDEN GATE, CAPARRA
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3413
Country	:	US
Telephone Number	:	787-245-2112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/13/2014

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Directions to “ DR. MARIA MERCEDES DE THOMAS D.M.D.” Practice Location

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