MEDICARE: DR. THOMAS H. WINGO JR. D.D.S

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	3483	LA

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	:	1679531412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS H. WINGO JR. D.D.S

Provider Business Mailing Address
First Line	:	1008 W THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3040
Country	:	US
Telephone Number	:	985-542-6855
Fax Number	:	985-542-6656

Provider Business Practice Location Address
First Line	:	1008 W THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3040
Country	:	US
Telephone Number	:	985-542-6855
Fax Number	:	985-542-6656

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	06/12/2012

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Directions to “ DR. THOMAS H. WINGO JR. D.D.S” Practice Location

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