MEDICARE: DR. THOMAS A THURSTON 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	MT1975	MT

General Provider Information

NPI Number	:	1235281403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A THURSTON D.M.D.

Provider Business Mailing Address
First Line	:	125 COMMONS WAY # 1
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1900
Country	:	US
Telephone Number	:	406-752-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 COMMONS WAY # 1
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1900
Country	:	US
Telephone Number	:	406-752-3737
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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