MEDICARE: DR. TIMOTHY ALLEN SLOAN 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	13512	TX

General Provider Information

NPI Number	:	1417956350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ALLEN SLOAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 787
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-0787
Country	:	US
Telephone Number	:	972-932-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 OLD KEMP HWY
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-3658
Country	:	US
Telephone Number	:	972-932-4312
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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