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NPI Code Detail

MEDICARE: DR. THOMAS J BEVELOCK D.M.D.

MEDICARE: DR. THOMAS J BEVELOCK 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
11223G0001XGeneral Practice DentistryDN 12865FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
165-0554804OTHERFLFEIN

General Provider Information

NPI Number : 1649321852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS J BEVELOCK D.M.D.
Provider Business Mailing Address
First Line : 10940 E STATE ROAD 70
Second Line : SUITE 102
City : BRADENTON
State : FL
Zip : 34202-8400
Country : US
Telephone Number : 941-756-9604
Fax Number : 941-756-0616
Provider Business Practice Location Address
First Line : 10940 E STATE ROAD 70
Second Line : SUITE 102
City : BRADENTON
State : FL
Zip : 34202-8400
Country : US
Telephone Number : 941-756-9604
Fax Number : 941-756-0616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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