MEDICARE: DR. THOMAS PATRICK ROONEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19016244	IL

General Provider Information

NPI Number	:	1235167602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK ROONEY DMD

Provider Business Mailing Address
First Line	:	1703 POLARIS CIR
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-1683
Country	:	US
Telephone Number	:	815-434-4500
Fax Number	:	815-434-4520

Provider Business Practice Location Address
First Line	:	1703 POLARIS CIR
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-1683
Country	:	US
Telephone Number	:	815-434-4500
Fax Number	:	815-434-4520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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