Healthcare Provider Details

I. General information

NPI: 1174722482
Provider Name (Legal Business Name): THOMAS ALBERT CIONI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N HIBBARD ST
STAUNTON IL
62088-1347
US

IV. Provider business mailing address

114 N HIBBARD ST
STAUNTON IL
62088-1347
US

V. Phone/Fax

Practice location:
  • Phone: 618-635-2522
  • Fax:
Mailing address:
  • Phone: 618-635-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: