Healthcare Provider Details

I. General information

NPI: 1679634372
Provider Name (Legal Business Name): THOMAS WILLIAM NOWASKEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 W COLONIAL PKWY SUITE 1B
INVERNESS IL
60067-4795
US

IV. Provider business mailing address

1622 W COLONIAL PKWY SUITE 1B
INVERNESS IL
60067-4795
US

V. Phone/Fax

Practice location:
  • Phone: 847-359-1751
  • Fax: 847-359-1787
Mailing address:
  • Phone: 847-359-1751
  • Fax: 847-359-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: