MEDICARE: DR. THOMAS J GREIST 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
1	122300000X	Dentist	019019397	IL

General Provider Information

NPI Number	:	1588873061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J GREIST DDS

Provider Business Mailing Address
First Line	:	840 S LAKE STREET
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060
Country	:	US
Telephone Number	:	847-949-9400
Fax Number	:	847-949-6373

Provider Business Practice Location Address
First Line	:	840 S LAKE STREET
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-3634
Country	:	US
Telephone Number	:	847-949-9400
Fax Number	:	847-949-6373

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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