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NPI Code Detail

MEDICARE: DR. DIMITRI VASDEKIS DDS

MEDICARE: DR. DIMITRI VASDEKIS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019028421IL

General Provider Information

NPI Number : 1376850891
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIMITRI VASDEKIS DDS
Provider Business Mailing Address
First Line : 3009 E 92ND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4502
Country : US
Telephone Number : 773-978-1231
Fax Number : 773-978-5136
Provider Business Practice Location Address
First Line : 3009 E 92ND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4502
Country : US
Telephone Number : 773-978-1231
Fax Number : 773-978-5136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2010
Last Update Date : 09/03/2010

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Directions to “ DR. DIMITRI VASDEKIS DDS” Practice Location

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