MEDICARE: DR. REGGIE M THURSTON 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	019024072	IL

General Provider Information

NPI Number	:	1821120932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGGIE M THURSTON DDS

Provider Business Mailing Address
First Line	:	1854 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3117
Country	:	US
Telephone Number	:	773-227-6721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3117
Country	:	US
Telephone Number	:	773-227-6721
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	12/23/2025

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