Provider Demographics
NPI:1699845677
Name:RAIA, THOMAS JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:RAIA
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 1:8661 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5694
Mailing Address - Country:US
Mailing Address - Phone:630-655-1257
Mailing Address - Fax:
Practice Address - Street 1:2410 CATON FARM ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1374
Practice Address - Country:US
Practice Address - Phone:815-439-1111
Practice Address - Fax:815-439-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice