Provider Demographics
NPI:1548393598
Name:THOMAS C POMIERSKI DDS JOHN S SULLIVAN DDS
Entity Type:Organization
Organization Name:THOMAS C POMIERSKI DDS JOHN S SULLIVAN DDS
Other - Org Name:MUNDELEIN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-566-5560
Mailing Address - Street 1:328 N LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060
Mailing Address - Country:US
Mailing Address - Phone:847-566-5560
Mailing Address - Fax:847-566-1311
Practice Address - Street 1:328 N LAKE STREET
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060
Practice Address - Country:US
Practice Address - Phone:847-566-5560
Practice Address - Fax:847-566-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty