Provider Demographics
NPI:1023217783
Name:MCDERMOTT, THOMAS JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N. MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:872-256-5003
Mailing Address - Fax:773-282-4962
Practice Address - Street 1:30 N. MICHIGAN AVE.
Practice Address - Street 2:SUITE 1803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:872-256-5003
Practice Address - Fax:773-282-4962
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0199941223G0001X
IL0190199941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice