MEDICARE: THOMAS FAMILY DENTAL

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	D4664	AZ
2	1223G0001X	General Practice Dentistry	D5123	AZ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508214172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS FAMILY DENTAL

Provider Business Mailing Address
First Line	:	7333 W THOMAS RD
Second Line	:	SUITE 72
City	:	PHOENIX
State	:	AZ
Zip	:	85033-5546
Country	:	US
Telephone Number	:	623-245-1000
Fax Number	:	623-245-1010

Provider Business Practice Location Address
First Line	:	7333 W THOMAS RD
Second Line	:	SUITE 72
City	:	PHOENIX
State	:	AZ
Zip	:	85033-5546
Country	:	US
Telephone Number	:	623-245-1000
Fax Number	:	623-245-1010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER SPILOTRO
Credential	:	D.D.S.
Telephone Number	:	623-680-9911

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “THOMAS FAMILY DENTAL ” Practice Location

Language	Start Address	Practice Location

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