MEDICARE: THOMAS S JENNINGS 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	6662	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770176	OTHER		UNITED CONCORDIA

General Provider Information

NPI Number	:	1083690291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS S JENNINGS DDS

Provider Business Mailing Address
First Line	:	2430 RESEARCH PKWY
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1093
Country	:	US
Telephone Number	:	719-590-7100
Fax Number	:	719-590-7223

Provider Business Practice Location Address
First Line	:	2430 RESEARCH PKWY
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1093
Country	:	US
Telephone Number	:	719-590-7100
Fax Number	:	719-590-7223

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	08/31/2009

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