Provider Demographics
NPI:1659619500
Name:STEVEN C THARP DDS PC
Entity Type:Organization
Organization Name:STEVEN C THARP DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CASIMIR
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-712-6521
Mailing Address - Street 1:10S267 KAYE LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6019
Mailing Address - Country:US
Mailing Address - Phone:815-712-6521
Mailing Address - Fax:
Practice Address - Street 1:10171 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1274
Practice Address - Country:US
Practice Address - Phone:815-712-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0283561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty