Provider Demographics
NPI:1831239193
Name:COUSTON, THOMAS G (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:COUSTON
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:SCHOOLHOUSE SQUARE DENTAL CENTER, P.C.
Mailing Address - Street 2:12 W SCHAUMBURG RD
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3502
Mailing Address - Country:US
Mailing Address - Phone:847-519-1711
Mailing Address - Fax:
Practice Address - Street 1:SCHOOLHOUSE SQUARE DENTAL CENTER, P.C.
Practice Address - Street 2:12 W SCHAUMBURG RD
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3502
Practice Address - Country:US
Practice Address - Phone:847-519-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice