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General NPI Number Information
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NPI Number | 1194194639
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Entity Type | Organization
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Legal Business Name | JOHN KATSIS D.D.S., LTD.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 110 S OAK AVE
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City | BARTLETT
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State | IL
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Zip | 60103-6621
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Country | US
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Telephone | 630-894-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S OAK AVE
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City | BARTLETT
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State | IL
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Zip | 60103-6621
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Country | US
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Telephone | 630-894-5557
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST / OWNER
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Name | DR. JOHN KATSIS JR.
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Credential | D.D.S., M.S.
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Telephone | 630-894-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019016097
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License Number State | IL
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