MEDICARE: MARC D. THOMAS D.D.S., P.C.

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	1223P0221X	Pediatric Dentistry	10771	CO

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	:	1447692538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARC D. THOMAS D.D.S., P.C.

Provider Business Mailing Address
First Line	:	4344 WOODLANDS BLVD
Second Line	:	SUITE 260
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-841-7900
Fax Number	:	303-688-6210

Provider Business Practice Location Address
First Line	:	4344 WOODLANDS BLVD
Second Line	:	SUITE 260
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-841-7900
Fax Number	:	303-688-6210

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. MARC DAVID THOMAS
Credential	:	D.D.S.
Telephone Number	:	303-841-7900

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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