MEDICARE: DR. THOMAS B ROLLINS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 13560	FL

General Provider Information

NPI Number	:	1942452099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS B ROLLINS DDS

Provider Business Mailing Address
First Line	:	2200 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9415
Country	:	US
Telephone Number	:	850-791-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9415
Country	:	US
Telephone Number	:	850-791-6300
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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