Provider Demographics
NPI:1225103955
Name:MAURICE, THOMAS J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MAURICE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24023 W LOCKPORT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1766
Mailing Address - Country:US
Mailing Address - Phone:815-439-7811
Mailing Address - Fax:
Practice Address - Street 1:1118 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3456
Practice Address - Country:US
Practice Address - Phone:815-439-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024694122300000X
IL0210018841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry