Healthcare Provider Details

I. General information

NPI: 1396244943
Provider Name (Legal Business Name): HLM DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 W MADISON ST
CHICAGO IL
60612-2228
US

IV. Provider business mailing address

2316 W MADISON ST
CHICAGO IL
60612-2228
US

V. Phone/Fax

Practice location:
  • Phone: 847-414-3309
  • Fax:
Mailing address:
  • Phone: 847-414-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019023680
License Number StateIL

VIII. Authorized Official

Name: DIMITRI HARALAMPOPOULOS
Title or Position: OFFICER
Credential:
Phone: 847-414-3309