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General NPI Number Information
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NPI Number | 1962822296
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Entity Type | Organization
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Legal Business Name | SOUTH HOLLAND DENTAL PC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 808 E SIBLEY BLVD
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City | DOLTON
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State | IL
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Zip | 60419-2130
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Country | US
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Telephone | 708-499-0100
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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 | DR. CHRIS TSALIAGOS
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Credential |
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Telephone | 708-499-0100
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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 | IL
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