Basic Information
| Provider Information | |||||||||
| NPI: | 1104972694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAKBROOK ENDODONTIC ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 OAKBROOK CTR | ||||||||
| Address2: | #714 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306543331 | ||||||||
| FaxNumber: | 6309542910 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 OAKBROOK CTR | ||||||||
| Address2: | #714 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306543331 | ||||||||
| FaxNumber: | 6309542910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIANAKAKIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6306543331 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S.,M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Endodontics |
No ID Information.