Provider Demographics
NPI:1023238797
Name:NORTHERN ILLINOIS ENDODONTICS, LTD
Entity type:Organization
Organization Name:NORTHERN ILLINOIS ENDODONTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:815-756-8881
Mailing Address - Street 1:3251 COMMERCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7908
Mailing Address - Country:US
Mailing Address - Phone:815-756-8881
Mailing Address - Fax:
Practice Address - Street 1:3251 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-7908
Practice Address - Country:US
Practice Address - Phone:815-756-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty