MEDICARE: DR. EDWIN MICHAEL THOMAS. JR. 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	1223E0200X	Endodontics	14400	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	043090133	OTHER	MA	TAX ID #

General Provider Information

NPI Number	:	1891894978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN MICHAEL THOMAS. JR. D.D.S.

Provider Business Mailing Address
First Line	:	477 WASHINGTON ST
Second Line	:	P.O. BOX 2049
City	:	ABINGTON
State	:	MA
Zip	:	02351-2417
Country	:	US
Telephone Number	:	781-878-2190
Fax Number	:	781-878-3011

Provider Business Practice Location Address
First Line	:	477 WASHINGTON ST
Second Line	:
City	:	ABINGTON
State	:	MA
Zip	:	02351-2417
Country	:	US
Telephone Number	:	781-878-2190
Fax Number	:	781-878-3011

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/16/2015

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