MEDICARE: DR. THOMAS OLIVER CONLON DDS

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	1223P0300X	Periodontics	DE00003792	WA

General Provider Information

NPI Number	:	1538273420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS OLIVER CONLON DDS

Provider Business Mailing Address
First Line	:	12509 E MISSION AVE
Second Line	:	SUITE 203
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1049
Country	:	US
Telephone Number	:	509-928-6464
Fax Number	:	509-924-8892

Provider Business Practice Location Address
First Line	:	12509 E MISSION AVE
Second Line	:	SUITE 203
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1049
Country	:	US
Telephone Number	:	509-928-6464
Fax Number	:	509-924-8892

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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