Provider Demographics
NPI:1326318718
Name:BRINKER-THOMAS, ALTHEA (RDH)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:
Last Name:BRINKER-THOMAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 W OGDEN AVE
Mailing Address - Street 2:ATTN: DENTAL DEPT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2459
Mailing Address - Country:US
Mailing Address - Phone:872-588-3223
Mailing Address - Fax:
Practice Address - Street 1:3851 W OGDEN AVE
Practice Address - Street 2:ATTN: DENTAL DEPT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2459
Practice Address - Country:US
Practice Address - Phone:872-588-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.009436124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist