Provider Demographics
NPI:1699813485
Name:MALONEY, THOMAS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:MALONEY
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 1:19125 LA GRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448
Mailing Address - Country:US
Mailing Address - Phone:708-479-2273
Mailing Address - Fax:708-479-7398
Practice Address - Street 1:19125 LA GRANGE ROAD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-479-2273
Practice Address - Fax:708-479-7398
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19172361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice