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General NPI Number Information
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NPI Number | 1104086008
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Entity Type | Organization
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Legal Business Name | KOTIS AND KANELLOS LTD
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 9206 S COMMERCIAL AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4508
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Country | US
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Telephone | 773-978-4447
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Fax | 773-978-7662
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Provider Business Mailing Address
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Address Line | 9206 S COMMERCIAL AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4508
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Country | US
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Telephone | 773-978-4447
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Fax | 773-978-7662
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JAMES P KANELLOS
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Credential | DDS
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Telephone | 773-978-4447
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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 | 060.005824
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License Number State | IL
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