MEDICARE: DR. THOMAS WILLIAM SIGRIST 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	122300000X	Dentist	3173619921	UT

General Provider Information

NPI Number	:	1992874317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WILLIAM SIGRIST D.D.S.

Provider Business Mailing Address
First Line	:	3518 ROBBIN CT
Second Line	:	2301 SANTA CLARA DR.
City	:	SANTA CLARA
State	:	UT
Zip	:	84765-5343
Country	:	US
Telephone Number	:	435-688-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 SANTA CLARA DR
Second Line	:
City	:	SANTA CLARA
State	:	UT
Zip	:	84765-5472
Country	:	US
Telephone Number	:	435-688-1577
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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