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General NPI Number Information
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NPI Number | 1649927773
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Entity Type | Organization
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Legal Business Name | SHAWN THOMAS DDS PLLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1924 HICKORY RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-2239
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Country | US
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Telephone | 708-798-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S WABASH AVE APT 1109
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City | CHICAGO
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State | IL
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Zip | 60605-2557
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Country | US
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Telephone | 440-390-8524
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. SHAWN THOMAS
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Credential | DDS
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Telephone | 440-390-8524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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