Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021001041 | IL |
NPI | 1003130147 |
---|---|
Provider Name | Dr. Thomas Edward Allaway |
First Address | Dekalb, IL 60115 |
Second Address | Dekalb, IL 60115-7908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 18/03/2010 |