Organization
DEMP FERN MG DENTAL CORP.
Active
Other names
James P Kanellos DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES P KANELLOS DDS (OWNER/DENTIST)
(312) 391-7529
Entity
Organization
Contact information
Practice address
6223 DEMPSTER ST, MORTON GROVE, IL 60053-2818
(847) 966-8000
(847) 832-1687
Mailing address
1112 INDIAN RD, GLENVIEW, IL 60025-3225
(847) 832-1684
(847) 832-1687
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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