MEDICARE: FARA THOMAS 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	1223G0001X	General Practice Dentistry	3221	NV

General Provider Information

NPI Number	:	1720280290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARA THOMAS D.D.S.

Provider Business Mailing Address
First Line	:	10080 ALTA DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8723
Country	:	US
Telephone Number	:	702-313-2300
Fax Number	:	702-309-4307

Provider Business Practice Location Address
First Line	:	10080 ALTA DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8723
Country	:	US
Telephone Number	:	702-313-2300
Fax Number	:	702-309-4307

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	04/28/2009

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