Fonner, Thomas W

Fonner, Thomas W is an individual health care provider with primary practice located at 100 Greenview Dr Ste B , Effingham IL 62401-3048. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Fonner, Thomas W can be contacted via phone (217) 540-5348.

Contact Information

Primary practice address
100 Greenview Dr Ste B Effingham IL 62401-3048
Phone: (217) 540-5348
Fax: (217) 540-5360
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 019-024942 Illinois

Profile Details

NPI number 1205907581
LBN Legal business name Fonner, Thomas W
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2006
Last updated Apr 4th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205907581 NPPES
Illinois MEDICAID 1014426

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