Provider Demographics
NPI:1558413369
Name:GERMINO, THOMAS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:GERMINO
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 1:9763 W 143RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2089
Mailing Address - Country:US
Mailing Address - Phone:708-349-3443
Mailing Address - Fax:708-403-5557
Practice Address - Street 1:9763 W 143RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2089
Practice Address - Country:US
Practice Address - Phone:708-349-3443
Practice Address - Fax:708-403-5557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190168621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice