MEDICARE: DR. VASSOS B. HAJIHARIS DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2901018486	MI
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4301086539	MI
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	019013377	IL

General Provider Information

NPI Number	:	1891916003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASSOS B. HAJIHARIS DDS, MD

Provider Business Mailing Address
First Line	:	7625 W 15TH STREET
Second Line	:
City	:	TINLEY PARK
State	:	FL
Zip	:	60477
Country	:	US
Telephone Number	:	708-429-4770
Fax Number	:	708-429-9685

Provider Business Practice Location Address
First Line	:	4435 W 95TH STREET
Second Line	:
City	:	OAKLAWN
State	:	IL
Zip	:	60453
Country	:	US
Telephone Number	:	313-499-4775
Fax Number	:	708-423-8552

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	11/18/2011

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