MEDICARE: DR. THOMAS J BALSHI 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	1223P0700X	Prosthodontics	DS017634L	PA

General Provider Information

NPI Number	:	1326108069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J BALSHI D.D.S.

Provider Business Mailing Address
First Line	:	1221 MEETINGHOUSE RD
Second Line	:
City	:	GWYNEDD
State	:	PA
Zip	:	19436
Country	:	US
Telephone Number	:	215-699-7694
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 PENNSYLVANIA AVE
Second Line	:	#201
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3420
Country	:	US
Telephone Number	:	215-646-6334
Fax Number	:	215-643-1149

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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