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General NPI Number Information
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NPI Number | 1194380741
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Entity Type | Individual
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Provider Name | VASILIKI KYTRIDOU D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 2800 COLLEGE AVENUE SOUTHERN IL UNIVERSITY SCHOOL OF DE BUILDING 285
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone | 612-474-7024
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Fax | 618-474-7249
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Provider Business Mailing Address
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Address Line | 2800 COLLEGE AVENUE SOUTHERN IL UNIVERSITY SCHOOL OF DE BUILDING 285
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone | 612-474-7120
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Fax | 618-474-7249
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 136000244
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License Number State | IL
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