MEDICARE: DR. PETER A. CONTOS D.D.S.

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	6639	WI
2	1223G0001X	General Practice Dentistry	019026750	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477606234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A. CONTOS D.D.S.

Provider Business Mailing Address
First Line	:	1120 MIDWAY RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-3938
Country	:	US
Telephone Number	:	847-804-9429
Fax Number	:	773-262-9850

Provider Business Practice Location Address
First Line	:	6428 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5209
Country	:	US
Telephone Number	:	773-973-0531
Fax Number	:	773-262-9850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	05/16/2023

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