Provider Demographics
NPI:1558560185
Name:THIRUMALA, GEETHA D (DMD)
Entity type:Individual
Prefix:DR
First Name:GEETHA
Middle Name:D
Last Name:THIRUMALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 LAKE CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4582
Mailing Address - Country:US
Mailing Address - Phone:857-753-0228
Mailing Address - Fax:
Practice Address - Street 1:1 E PHILLIP RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1858
Practice Address - Country:US
Practice Address - Phone:847-367-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10017491223P0221X
IL0210028721223P0221X
IL0190317361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice