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NPI Code Detail

MEDICARE: JOHN G. IFANTIS D.D.S., P.C.

MEDICARE: JOHN G. IFANTIS D.D.S., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1134274657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN G. IFANTIS D.D.S., P.C.
Provider Business Mailing Address
First Line : 9251 WAUKEGAN RD
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2102
Country : US
Telephone Number : 847-663-0003
Fax Number : 847-663-0390
Provider Business Practice Location Address
First Line : 9251 WAUKEGAN RD
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2102
Country : US
Telephone Number : 847-663-0003
Fax Number : 847-663-0390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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