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NPI Code Detail

MEDICARE: DR. THOMAS MICHAEL DEWERD DDS

MEDICARE: DR. THOMAS MICHAEL DEWERD 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
1122300000XDentistD9357MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1982220800OTHERMNMHCP PROVIDER NUMBER

General Provider Information

NPI Number : 1316113624
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MICHAEL DEWERD DDS
Provider Business Mailing Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-522-4451
Fax Number : 763-522-2464
Provider Business Practice Location Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-522-4451
Fax Number : 763-522-2464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2008
Last Update Date : 05/06/2008

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