Individual
DAVILIQUA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
7215 N BELL AVE, CHICAGO, IL 60645-2046
(224) 627-7865
Mailing address
7215 N BELL AVE, CHICAGO, IL 60645-2046
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0200013282
IL
124Q00000X
Dental Hygienist
16719
TX
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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