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NPI Code Detail

MEDICARE: DR. THOMAS BEZOUSKA DDS

MEDICARE:  DR. THOMAS  BEZOUSKA  DDS
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1407941362
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS BEZOUSKA DDS
Provider Business Mailing Address
First Line : 3930 WASHINGTON ST
Second Line : SUITE A
City : GURNEE
State : IL
Zip : 60031-5702
Country : US
Telephone Number : 847-623-4888
Fax Number : 847-623-0117
Provider Business Practice Location Address
First Line : 3930 WASHINGTON ST
Second Line : SUITE A
City : GURNEE
State : IL
Zip : 60031-5702
Country : US
Telephone Number : 847-623-4888
Fax Number : 847-623-0117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ DR. THOMAS BEZOUSKA DDS” Practice Location

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