Provider Demographics
NPI:1114395316
Name:THOMAS R POINTNER, LLC
Entity Type:Organization
Organization Name:THOMAS R POINTNER, LLC
Other - Org Name:FOX VALLEY DENTAL CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:POINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-695-1300
Mailing Address - Street 1:74 N ALFRED AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5262
Mailing Address - Country:US
Mailing Address - Phone:847-695-1300
Mailing Address - Fax:847-695-8133
Practice Address - Street 1:74 N ALFRED AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5262
Practice Address - Country:US
Practice Address - Phone:847-695-1300
Practice Address - Fax:847-695-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022965122300000X
IL019029509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty