MEDICARE: DR. TOM SERAFICA VELORIA 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	D00140	GU

General Provider Information

NPI Number	:	1821329285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM SERAFICA VELORIA D.M.D.

Provider Business Mailing Address
First Line	:	415 CHALAN SAN ANTONIO
Second Line	:	SUITE 303
City	:	TAMUNING
State	:	GU
Zip	:	96913-3620
Country	:	US
Telephone Number	:	671-646-5146
Fax Number	:	671-646-8690

Provider Business Practice Location Address
First Line	:	415 CHALAN SAN ANTONIO
Second Line	:	SUITE 303
City	:	TAMUNING
State	:	GU
Zip	:	96913-3620
Country	:	US
Telephone Number	:	671-646-5146
Fax Number	:	671-646-8690

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

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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