DR. THOMAS W FONNER DMD NPI 1205907581

NPI Information

  • NPI: 1205907581
  • Provider Name: DR. THOMAS W FONNER, DMD
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 100 GREENVIEW DR STE B
    EFFINGHAM, IL
    ZIP 62401
  • Phone: (217) 540-5348

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NPI Details

DR. Thomas W Fonner, DMD is an oral and maxillofacial surgery dentist in Effingham, IL with 30 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Thomas W Fonner, DMD NPI is 1205907581. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: SOUTHERN ILLINOIS UNIV SCHOOL OF DENTAL MEDICINE
Graduation Year:1995

The provider's business location address is:

100 GREENVIEW DR STE B
EFFINGHAM, IL
ZIP 62401-048
Phone: (217) 540-5348
Fax: (217) 540-5360

The NPI 1205907581 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Melanoma (skin cancer) excision (HCPCS:NAN03)

The enumeration date for this NPI number is 11/10/2006 and was last updated on 4/4/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery019-024942ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11014426MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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