MEDICARE: DR. DOUGLAS ARTHUR TOMLINSON 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	122300000X	Dentist	2004026597	MO
2	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1588654255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ARTHUR TOMLINSON D.M.D.

Provider Business Mailing Address
First Line	:	529 TENNEY ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3746
Country	:	US
Telephone Number	:	309-853-3684
Fax Number	:	309-852-0140

Provider Business Practice Location Address
First Line	:	529 TENNEY ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3746
Country	:	US
Telephone Number	:	309-853-3684
Fax Number	:	309-852-0140

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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