Provider Demographics
NPI:1811003981
Name:MAUROVICH, THOMAS JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MAUROVICH
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 1:1001 E MAIN STREET
Mailing Address - Street 2:STE F
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-513-5500
Mailing Address - Fax:630-513-5500
Practice Address - Street 1:1001 E MAIN STREET
Practice Address - Street 2:STE F
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-513-5500
Practice Address - Fax:630-513-5500
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A13882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist