MEDICARE: DR. PHELAN RICO THOMAS 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	122300000X	Dentist	07198	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07198	OTHER	IA	DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1144393034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHELAN RICO THOMAS DDS

Provider Business Mailing Address
First Line	:	4100 UNIVERSITY AVE STE 105
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5958
Country	:	US
Telephone Number	:	515-223-8800
Fax Number	:	515-223-1437

Provider Business Practice Location Address
First Line	:	4100 UNIVERSITY AVE
Second Line	:	SUITE 105
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5956
Country	:	US
Telephone Number	:	515-223-8800
Fax Number	:	515-223-1437

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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