MEDICARE: DR. ROBERT H THALGOTT DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	1000053-290	NV

General Provider Information

NPI Number	:	1457453797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT H THALGOTT DMD, MS

Provider Business Mailing Address
First Line	:	1945 VILLAGE CENTER CIR
Second Line	:	SUITE #110
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6258
Country	:	US
Telephone Number	:	702-364-5100
Fax Number	:	702-364-5732

Provider Business Practice Location Address
First Line	:	1945 VILLAGE CENTER CIR
Second Line	:	SUITE #110
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6258
Country	:	US
Telephone Number	:	702-364-5100
Fax Number	:	702-364-5732

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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