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General NPI Number Information
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NPI Number | 1386171056
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Entity Type | Organization
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Legal Business Name | DR. THOMAS AUTOBEE
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 108 E PITKIN AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2110
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Country | US
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Telephone | 719-543-8940
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Fax | 719-543-9926
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Provider Business Mailing Address
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Address Line | 108 E PITKIN AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2110
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Country | US
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Telephone | 719-543-8940
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Fax | 719-543-9926
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS AUTOBEE
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Credential | DDS
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Telephone | 719-543-8940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00104104
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License Number State | CO
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