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NPI Code Detail

MEDICARE: DR. CHRISTOS A TSALIAGOS D.D.S.

MEDICARE: DR. CHRISTOS A TSALIAGOS D.D.S.
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
1122300000XDentist019023116IL

General Provider Information

NPI Number : 1700051810
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOS A TSALIAGOS D.D.S.
Provider Business Mailing Address
First Line : 440 W HURON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3495
Country : US
Telephone Number : 312-804-8442
Fax Number : 773-622-6191
Provider Business Practice Location Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number : 773-622-6191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 04/29/2008

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