MEDICARE: TOMMY PAGONIS 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22DI02348100	NJ

General Provider Information

NPI Number	:	1780883769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMY PAGONIS DDS

Provider Business Mailing Address
First Line	:	1358 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2882
Country	:	US
Telephone Number	:	732-914-2224
Fax Number	:	732-914-0087

Provider Business Practice Location Address
First Line	:	1358 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2882
Country	:	US
Telephone Number	:	732-914-2224
Fax Number	:	732-914-0087

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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