Provider Demographics
NPI:1871860429
Name:FIOCCHI, THOMAS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:FIOCCHI
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 1:2685 WAUKEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1430
Mailing Address - Country:US
Mailing Address - Phone:847-432-1111
Mailing Address - Fax:847-432-3201
Practice Address - Street 1:2685 WAUKEGAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1430
Practice Address - Country:US
Practice Address - Phone:847-432-1111
Practice Address - Fax:847-432-3201
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190185861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice