Provider Demographics
NPI:1700014297
Name:THOMAS, ROBERT L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8346
Mailing Address - Country:US
Mailing Address - Phone:630-554-5600
Mailing Address - Fax:630-554-5626
Practice Address - Street 1:2844 ROUTE 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8346
Practice Address - Country:US
Practice Address - Phone:630-554-5600
Practice Address - Fax:630-554-5626
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190250911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics