Provider Demographics
NPI:1245587997
Name:SKOUMAL, THOMAS EDWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:SKOUMAL
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 1:302 RANDALL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-232-7385
Mailing Address - Fax:630-232-7389
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-232-7385
Practice Address - Fax:630-232-7389
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190291921223G0001X
IA089781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice