MEDICARE: DR. ROBERT ROLAND THORUP 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	144521-9922	UT

General Provider Information

NPI Number	:	1396804423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ROLAND THORUP D.D.S

Provider Business Mailing Address
First Line	:	7138 HIGHLAND DR STE 218
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3779
Country	:	US
Telephone Number	:	801-944-9494
Fax Number	:	801-944-9815

Provider Business Practice Location Address
First Line	:	7138 HIGHLAND DR STE 218
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3779
Country	:	US
Telephone Number	:	801-944-9494
Fax Number	:	801-944-9815

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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