MEDICARE: PHILIP J GIRGIS DMD PC

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
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1174699623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP J GIRGIS DMD PC

Provider Business Mailing Address
First Line	:	4707 WILLOW SPRINGS RD
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6144
Country	:	US
Telephone Number	:	708-352-1320
Fax Number	:	708-588-1750

Provider Business Practice Location Address
First Line	:	4707 WILLOW SPRINGS RD
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6144
Country	:	US
Telephone Number	:	708-352-1320
Fax Number	:	708-588-1750

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. PHILIP JOSEPH GIRGIS
Credential	:	D.M.D.
Telephone Number	:	708-352-1320

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/22/2020

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