Provider Demographics
NPI:1578970042
Name:THOMAS SKOUMAL DDS, PC
Entity Type:Organization
Organization Name:THOMAS SKOUMAL DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:SKOUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-232-7385
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-232-7385
Mailing Address - Fax:630-232-7389
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-232-7385
Practice Address - Fax:630-232-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029192261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental