MEDICARE: DR. THOMAS J VERHOFF 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	1223G0001X	General Practice Dentistry	30013774	OH

General Provider Information

NPI Number	:	1245345453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J VERHOFF D.D.S.

Provider Business Mailing Address
First Line	:	5116 E WALNUT ST
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-9612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5797 BEECHCROFT RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2758
Country	:	US
Telephone Number	:	614-891-0440
Fax Number	:	614-891-0428

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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