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NPI Code Detail

MEDICARE: THOMAS M DEWERD DDS PA

MEDICARE: THOMAS M DEWERD DDS PA
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
1122300000XDentistD9357MN

General Provider Information

NPI Number : 1922099845
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMAS M DEWERD DDS PA
Provider Business Mailing Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-522-4451
Fax Number : 763-522-2464
Provider Business Practice Location Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-522-4451
Fax Number : 763-522-2464
Authorized Official
Title or Position : PRESIDENT
Name : DR. THOMAS MICHAEL DEWERD
Credential : DDS
Telephone Number : 763-522-4451
Provider Enumeration Date : 10/31/2005
Last Update Date : 08/22/2020

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