Individual
DR. THOMAS MICHAEL DEWERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3359 W BROADWAY AVE, ROBBINSDALE, MN 55422-2928
(763) 522-4451
(763) 522-2464
Mailing address
3359 W BROADWAY AVE, ROBBINSDALE, MN 55422-2928
(763) 522-4451
(763) 522-2464
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9357
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
982220800
MHCP PROVIDER NUMBER
MN
Enumeration date
05/06/2008
Last updated
05/06/2008
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