Provider Demographics
NPI:1457406852
Name:BORDIGNON, THOMAS V (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:V
Last Name:BORDIGNON
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 1:1730 DEWES ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4316
Mailing Address - Country:US
Mailing Address - Phone:847-724-2160
Mailing Address - Fax:847-729-8814
Practice Address - Street 1:1730 DEWES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4316
Practice Address - Country:US
Practice Address - Phone:847-724-2160
Practice Address - Fax:847-729-8814
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist