Provider Demographics
NPI:1518048487
Name:FIORENZA, THOMAS PETER (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PETER
Last Name:FIORENZA
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 1:9500 S 50TH CT
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3094
Mailing Address - Country:US
Mailing Address - Phone:708-424-0080
Mailing Address - Fax:708-424-3754
Practice Address - Street 1:9500 S 50TH CT
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3094
Practice Address - Country:US
Practice Address - Phone:708-424-0080
Practice Address - Fax:708-424-3754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice