Provider Demographics
NPI:1497883862
Name:LOUGHARY, THOMAS MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:LOUGHARY
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 1:1515 W WALNUT ST
Mailing Address - Street 2:BUILDING 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1150
Mailing Address - Country:US
Mailing Address - Phone:217-243-6489
Mailing Address - Fax:217-245-0946
Practice Address - Street 1:1515 W WALNUT ST
Practice Address - Street 2:BUILDING 10
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1150
Practice Address - Country:US
Practice Address - Phone:217-243-6489
Practice Address - Fax:217-245-0946
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice