Provider Demographics
NPI:1124406822
Name:THOMAS, MICHAEL GEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEO
Last Name:THOMAS
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 1:1940 W GALENA BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4482
Mailing Address - Country:US
Mailing Address - Phone:630-892-8224
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD STE 7
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4482
Practice Address - Country:US
Practice Address - Phone:630-892-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190314301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice