Healthcare Provider Details

I. General information

NPI: 1891916003
Provider Name (Legal Business Name): VASSOS B. HAJIHARIS DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 W 95TH STREET
OAKLAWN IL
60453
US

IV. Provider business mailing address

7625 W 15TH STREET
TINLEY PARK FL
60477
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax: 708-423-8552
Mailing address:
  • Phone: 708-429-4770
  • Fax: 708-429-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901018486
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4301086539
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019013377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: