MEDICARE: SANDRA LOU WEBB-THOMPSON D.M.D.

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	3106-99	MS

General Provider Information

NPI Number	:	1770638660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LOU WEBB-THOMPSON D.M.D.

Provider Business Mailing Address
First Line	:	4723 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-485-0550
Fax Number	:	601-485-9723

Provider Business Practice Location Address
First Line	:	4723 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-485-0550
Fax Number	:	601-485-9723

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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