Provider Demographics
NPI:1083797856
Name:DONOHUE, THOMAS M (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOBSON RD
Mailing Address - Street 2:STE 224
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8138
Mailing Address - Country:US
Mailing Address - Phone:630-961-0996
Mailing Address - Fax:630-579-0850
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:STE 224
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:630-961-0996
Practice Address - Fax:630-579-0850
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0013091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry