MEDICARE: DR. THOMAS J MCAVOY D.D.S.

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	1223G0001X	General Practice Dentistry	5184	WA

General Provider Information

NPI Number	:	1457418394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J MCAVOY D.D.S.

Provider Business Mailing Address
First Line	:	1710 LAFAYETTE ST
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388-1328
Country	:	US
Telephone Number	:	253-582-3106
Fax Number	:	253-582-0228

Provider Business Practice Location Address
First Line	:	1710 LAFAYETTE ST
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388-1328
Country	:	US
Telephone Number	:	253-582-3106
Fax Number	:	253-582-0228

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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