Provider Demographics
NPI:1982943023
Name:OLGA L THURMAN DDS LTD
Entity Type:Organization
Organization Name:OLGA L THURMAN DDS LTD
Other - Org Name:DENTAL ON 45 INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-541-4066
Mailing Address - Street 1:34484 N US HIGHWAY 45
Mailing Address - Street 2:SUITE C
Mailing Address - City:THIRD LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-4038
Mailing Address - Country:US
Mailing Address - Phone:224-541-4066
Mailing Address - Fax:847-752-8425
Practice Address - Street 1:34484 N US HIGHWAY 45
Practice Address - Street 2:SUITE C
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4038
Practice Address - Country:US
Practice Address - Phone:224-541-4066
Practice Address - Fax:847-752-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental