MEDICARE: MICHAEL S. TODD D.M.D., LLC

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	015815	MO

General Provider Information

NPI Number	:	1053568865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S. TODD D.M.D., LLC

Provider Business Mailing Address
First Line	:	1500 VANDIVER DR
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3932
Country	:	US
Telephone Number	:	573-814-1694
Fax Number	:	573-814-2845

Provider Business Practice Location Address
First Line	:	1500 VANDIVER DR
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3932
Country	:	US
Telephone Number	:	573-814-1694
Fax Number	:	573-814-2845

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS KERRI L SMITH
Credential	:
Telephone Number	:	573-814-1694

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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