MEDICARE: THOMAS ROWE DENTISTRY PLLC

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	122300000X	Dentist	202040	CO

General Provider Information

NPI Number	:	1790143600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS ROWE DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 8737
Second Line	:
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-9000
Country	:	US
Telephone Number	:	970-453-4585
Fax Number	:	970-547-9145

Provider Business Practice Location Address
First Line	:	400 N PARK AVE
Second Line	:	#12A
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-8709
Country	:	US
Telephone Number	:	970-453-4585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS NELSON ROWE
Credential	:	DDS
Telephone Number	:	303-915-0439

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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