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General NPI Number Information
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NPI Number | 1306176615
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Entity Type | Organization
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Legal Business Name | LEE C DRAHOS, DDS, PC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 6800 W ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2312
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Country | US
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Telephone | 773-788-1001
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Fax | 773-788-1388
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Provider Business Mailing Address
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Address Line | 6800 W ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2312
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Country | US
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Telephone | 773-788-1001
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Fax | 773-788-1388
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. LEE C DRAHOS
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Credential | DDS
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Telephone | 773-788-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019025635
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License Number State | IL
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