MEDICARE: A. TED TWESME, D.D.S., LTD.

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	S2-14	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447422035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. TED TWESME, D.D.S., LTD.

Provider Business Mailing Address
First Line	:	4544 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0900
Fax Number	:	702-436-0636

Provider Business Practice Location Address
First Line	:	4544 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0900
Fax Number	:	702-436-0636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALBERT THEODORE TWESME
Credential	:	D.D.S.
Telephone Number	:	702-436-0900

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/24/2008

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