MEDICARE: DR. THOMAS ERIK NEAFUS D.D.S.

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	1223E0200X	Endodontics	D11136	MN

General Provider Information

NPI Number	:	1235293564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ERIK NEAFUS D.D.S.

Provider Business Mailing Address
First Line	:	12 WILDFLOWER PL
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-6221
Country	:	US
Telephone Number	:	651-340-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 150
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-481-8443
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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