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General NPI Number Information
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NPI Number | 1255785994
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Entity Type | Individual
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Provider Name | DAVILIQUA THOMAS R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 7215 N BELL AVE
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City | CHICAGO
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State | IL
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Zip | 60645-2046
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Country | US
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Telephone | 224-627-7865
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Fax |
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Provider Business Mailing Address
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Address Line | 7215 N BELL AVE
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City | CHICAGO
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State | IL
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Zip | 60645-2046
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0200013282
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 16719
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License Number State | TX
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