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General NPI Number Information
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NPI Number | 1225402795
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Entity Type | Organization
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Legal Business Name | DGBDDS LLC, DENISE MANIAKOURAS, DDS
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Dates
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Enumeration Date | 11/21/2015
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Last Update Date | 11/21/2015
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Provider Practice Location Address
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Address Line | 39 E COLORADO AVE
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City | FRANKFORT
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State | IL
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Zip | 60423-1385
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Country | US
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Telephone | 708-789-9289
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Fax | 708-789-9285
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Provider Business Mailing Address
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Address Line | 39 E COLORADO AVE
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City | FRANKFORT
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State | IL
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Zip | 60423-1385
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Country | US
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Telephone | 708-789-9289
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Fax | 708-789-9285
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DENISE D MANIAKOURAS
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Credential | DDS
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Telephone | 708-789-9289
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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 | 021002534
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License Number State | IL
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