1104972694 NPI number — OAKBROOK ENDODONTIC ASSOCIATES, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104972694 NPI number — OAKBROOK ENDODONTIC ASSOCIATES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKBROOK ENDODONTIC ASSOCIATES, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104972694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 OAKBROOK CTR
Provider Second Line Business Mailing Address:
#714
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-654-3331
Provider Business Mailing Address Fax Number:
630-954-2910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OAKBROOK CTR
Provider Second Line Business Practice Location Address:
#714
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-654-3331
Provider Business Practice Location Address Fax Number:
630-954-2910
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIANAKAKIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-654-3331

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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