MEDICARE: DR. THOMAS F WITHERSPOON DDS

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	3045	LA

General Provider Information

NPI Number	:	1730303140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS F WITHERSPOON DDS

Provider Business Mailing Address
First Line	:	11861 COURSEY BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4404
Country	:	US
Telephone Number	:	225-292-2273
Fax Number	:	225-292-2272

Provider Business Practice Location Address
First Line	:	11861 COURSEY BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4404
Country	:	US
Telephone Number	:	225-292-2273
Fax Number	:	225-292-2272

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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