MEDICARE: THOMAS ORTHODONTICS, PC

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

General Provider Information

NPI Number	:	1609553817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	5355 COLONY DR N
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-7056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5355 COLONY DR N
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-7056
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING LEAD
Name	:	JENNY GARCIA-ROCHA
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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