MEDICARE: DR. ROBERT WELDON THOMPSON 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	122300000X	Dentist	013954	MO

General Provider Information

NPI Number	:	1346256435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WELDON THOMPSON D.D.S.

Provider Business Mailing Address
First Line	:	1319 CAULKS HILL RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-6863
Country	:	US
Telephone Number	:	636-441-3430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 CAULKS HILL RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-6863
Country	:	US
Telephone Number	:	636-441-3430
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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