Organization
DIMOULIS DENTAL P.C.
Active
Other names
The Dental Office At Melrose Park
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE HARRY DIMOULIS D.M.D. (OWNER/DENTIST)
(847) 651-2692
Entity
Organization
Contact information
Practice address
818 N 19TH AVE, MELROSE PARK, IL 60160-3726
(708) 450-1170
(708) 450-0008
Mailing address
818 N 19TH AVE, MELROSE PARK, IL 60160-3726
(708) 450-1170
(708) 450-0008
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.030253
IL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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