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General NPI Number Information
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NPI Number | 1447569439
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Entity Type | Organization
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Legal Business Name | SJNOMOS
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 8301 S BRANDON AVE
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City | CHICAGO
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State | IL
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Zip | 60617-2656
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Country | US
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Telephone | 773-375-6199
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 KILPATRICK AVE
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City | SKOKIE
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State | IL
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Zip | 60076-3013
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Country | US
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Telephone | 773-430-9216
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVE JAMES KLERONOMOS
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Credential | DDS
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Telephone | 773-430-9216
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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 | 019019657
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License Number State | IL
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