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General NPI Number Information
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NPI Number | 1174713341
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Entity Type | Individual
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Provider Name | SOULTANA CHATZOPOULOS POPE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 632 GREEN BAY RD
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City | KENILWORTH
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State | IL
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Zip | 60043-1003
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Country | US
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Telephone | 847-728-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 WILMETTE AVE UNIT 1F
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City | CHICAGO
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State | IL
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Zip | 60657-2378
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002391
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License Number State | IL
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