Healthcare Provider Details

I. General information

NPI: 1871664672
Provider Name (Legal Business Name): LOUIS N KOROMPILAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10713 W 159TH ST
ORLAND PARK IL
60467
US

IV. Provider business mailing address

10713 W 159TH ST
ORLAND PARK IL
60467
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-5000
  • Fax: 708-403-8966
Mailing address:
  • Phone: 708-301-5000
  • Fax: 708-403-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: