=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740359991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES P. ECONOMOS, D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W BARTLETT AVE
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60103-7880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-830-4930
-----------------------------------------------------
Fax | 630-830-4953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 W BARTLETT AVE
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60103-7880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-830-4930
-----------------------------------------------------
Fax | 630-830-4953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES PETER ECONOMOS
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 630-830-4930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 19016838IL
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 19016838IL
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19016838IL
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------