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Organization
A-DENTA CARE SPECIALIST PC
Active
Organization
A-DENTA CARE SPECIALIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DIMOULIS DDS MS (OWNER)
(773) 769-1754
Entity
Organization
Contact information
Practice address
5780 N LINCOLN AVE, CHICAGO, IL 60659-4721
(773) 769-1754
(773) 769-1370
Mailing address
5780 N LINCOLN AVE, CHICAGO, IL 60659-4721
(773) 769-1754
(773) 769-1370
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
021002411
IL
1223E0200X
Endodontics
021002414
IL
1223P0300X
Periodontics
Primary
021001402
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136645657
NPI DENTAL PROVIDER
IL
01
—
1619133345
NPI DENTAL PROVIDER
IL
01
—
1962592865
DENTAL PROVIDER
IL
Enumeration date
03/23/2012
Last updated
03/23/2012
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