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NPI Code Detail

MEDICARE: DR. JAMES P KANELLOS DDS

MEDICARE: DR. JAMES P KANELLOS DDS
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 Dentistry019023220IL

General Provider Information

NPI Number : 1255322038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES P KANELLOS DDS
Provider Business Mailing Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-4447
Fax Number : 773-978-7662
Provider Business Practice Location Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-4447
Fax Number : 773-978-7662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 03/13/2013

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Directions to “ DR. JAMES P KANELLOS DDS” Practice Location

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