Provider Demographics
NPI:1619050093
Name:THOMAS E. DAVEY, D.M.D., P.C.
Entity Type:Organization
Organization Name:THOMAS E. DAVEY, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-877-2172
Mailing Address - Street 1:1353 E MOUND RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3678
Mailing Address - Country:US
Mailing Address - Phone:217-877-2172
Mailing Address - Fax:
Practice Address - Street 1:1353 E MOUND RD STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3678
Practice Address - Country:US
Practice Address - Phone:217-877-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty