Healthcare Provider Details

I. General information

NPI: 1831494509
Provider Name (Legal Business Name): SPIRO C. KARRAS, DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 DEMPSTER ST
MORTON GROVE IL
60053-3027
US

IV. Provider business mailing address

5818 DEMPSTER ST
MORTON GROVE IL
60053-3027
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-6647
  • Fax:
Mailing address:
  • Phone: 847-677-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019023117
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SPIRO C KARRAS
Title or Position: PRESIDENT
Credential:
Phone: 847-677-6647