Healthcare Provider Details

I. General information

NPI: 1497746739
Provider Name (Legal Business Name): BILL J KOTIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9206 S COMMERCIAL AVE
CHICAGO IL
60617-4508
US

IV. Provider business mailing address

9206 S COMMERCIAL AVE
CHICAGO IL
60617-4508
US

V. Phone/Fax

Practice location:
  • Phone: 773-978-4447
  • Fax: 773-978-7662
Mailing address:
  • Phone: 773-978-4447
  • Fax: 773-978-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: