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General NPI Number Information
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NPI Number | 1972450138
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Entity Type | Organization
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Legal Business Name | ELIZABETH T KALLIATH DMD PC
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE STE 1820
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City | CHICAGO
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State | IL
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Zip | 60602-2973
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Country | US
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Telephone | 312-236-3633
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Fax |
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Provider Business Mailing Address
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Address Line | 3037 N SEMINARY AVE
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City | CHICAGO
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State | IL
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Zip | 60657-4335
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Country | US
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Telephone | 256-810-1987
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ELIZABETH KALLIATH
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Credential | DMD
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Telephone | 256-810-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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