Provider Demographics
NPI:1760570618
Name:PIAZZA, THOMAS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:PIAZZA
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 1:10 W MARTIN AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6535
Mailing Address - Country:US
Mailing Address - Phone:630-357-6400
Mailing Address - Fax:630-357-7846
Practice Address - Street 1:10 W MARTIN AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6535
Practice Address - Country:US
Practice Address - Phone:630-357-6400
Practice Address - Fax:630-357-7846
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice