Provider Demographics
NPI:1679634372
Name:NOWASKEY, THOMAS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:NOWASKEY
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 1:1622 W COLONIAL PKWY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4795
Mailing Address - Country:US
Mailing Address - Phone:847-359-1751
Mailing Address - Fax:847-359-1787
Practice Address - Street 1:1622 W COLONIAL PKWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4795
Practice Address - Country:US
Practice Address - Phone:847-359-1751
Practice Address - Fax:847-359-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice