MEDICARE: DR. NICKOLAS GEORGIOPOULOS 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
1	122300000X	Dentist	019022842	IL

General Provider Information

NPI Number	:	1821200379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICKOLAS GEORGIOPOULOS DDS

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:	773-525-4632

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3524
Country	:	US
Telephone Number	:	773-561-3368
Fax Number	:	773-293-8968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/10/2024

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