Healthcare Provider Details

I. General information

NPI: 1780234039
Provider Name (Legal Business Name): DR. SUSAN THOMAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N NORTHWEST HWY
PARK RIDGE IL
60068-3366
US

IV. Provider business mailing address

303 N NORTHWEST HWY
PARK RIDGE IL
60068-3366
US

V. Phone/Fax

Practice location:
  • Phone: 847-825-2277
  • Fax: 312-264-0953
Mailing address:
  • Phone: 847-825-2277
  • Fax: 312-264-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN T THOMAS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 713-471-2654