MEDICARE: DR. THOMAS GLENN ROBERTS 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	5865	WA

General Provider Information

NPI Number	:	1235222951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS GLENN ROBERTS DDS

Provider Business Mailing Address
First Line	:	100 W HARRISON ST
Second Line	:	N. TOWER #150
City	:	SEATTLE
State	:	WA
Zip	:	98119-4116
Country	:	US
Telephone Number	:	206-284-4412
Fax Number	:	206-217-0195

Provider Business Practice Location Address
First Line	:	100 W HARRISON ST
Second Line	:	N. TOWER #150
City	:	SEATTLE
State	:	WA
Zip	:	98119-4116
Country	:	US
Telephone Number	:	206-284-4412
Fax Number	:	206-217-0195

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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