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General NPI Number Information
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NPI Number | 1881181329
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Entity Type | Individual
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Provider Name | SOUMYA ANN THOMAS DDS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 641 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 773-388-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 859 W ERIE ST APT 601
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City | CHICAGO
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State | IL
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Zip | 60642-7297
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Country | US
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Telephone | 972-898-1296
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34804
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019034244
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License Number State | IL
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