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General NPI Number Information
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NPI Number | 1538577085
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Entity Type | Organization
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Legal Business Name | METROSMILES - ARCHER HEIGHTS DENTAL
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 5141 S CICERO AVE
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City | CHICAGO
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State | IL
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Zip | 60632
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Country | US
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Telephone | 773-925-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 4842 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2531
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Country | US
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Telephone | 708-222-8302
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOS TSALIAGOS
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Credential |
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Telephone | 708-499-0900
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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 |
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License Number State |
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