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General NPI Number Information
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NPI Number | 1003254947
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Entity Type | Organization
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Legal Business Name | PETER A DRAHOS DDS PC
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 9118 OGDEN AVE UNIT B
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City | BROOKFIELD
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State | IL
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Zip | 60513-1974
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Country | US
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Telephone | 773-516-1262
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Fax |
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Provider Business Mailing Address
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Address Line | 9118 OGDEN AVE UNIT B
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City | BROOKFIELD
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State | IL
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Zip | 60513-1974
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Country | US
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Telephone | 773-516-1262
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Fax |
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Authorized Official
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Title or Position | DENTIST - PRESIDENT
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Name | DR. PETER ANDREW DRAHOS
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Credential | DDS
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Telephone | 773-516-1262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019027907
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License Number State | IL
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