Provider Demographics
NPI:1396333514
Name:THOMAS, DIANE (RDH, OMT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S HALE ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6913
Mailing Address - Country:US
Mailing Address - Phone:847-530-4989
Mailing Address - Fax:
Practice Address - Street 1:324 S HALE ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6913
Practice Address - Country:US
Practice Address - Phone:847-530-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
IL20006959124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist