Thomas Edward Allaway, D.D.S., M.S.
Individual provider Active NPI Endodontics · Dekalb, IL
NPI 1003130147 · NPPES record last updated Mar 18, 2010
Key facts
- NPI
- 1003130147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 021001041 (IL)
- Practice address
- 3251 Commerce Dr Ste a
Dekalb, IL 60115-7908 - Phone
- (815) 756-8881
- Fax
- (815) 756-8882
- NPI assigned
- Mar 18, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021001041 | IL | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Illinois Endodontics, LTD | Endodontics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 021001041 | IL | Yes |
Addresses
Primary practice location
3251 Commerce Dr Ste a
Dekalb, IL 60115-7908
Mailing address
3251A Commerce Dr.
Dekalb, IL 60115
Phone (815) 756-8881
Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.