Provider Demographics
NPI:1043389299
Name:ALBERTTIS, CARLOS J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:ALBERTTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 W LAKE ST
Mailing Address - Street 2:P.O.BOX.8373
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3728
Mailing Address - Country:US
Mailing Address - Phone:708-345-6636
Mailing Address - Fax:708-345-6671
Practice Address - Street 1:1908 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3728
Practice Address - Country:US
Practice Address - Phone:708-345-6636
Practice Address - Fax:708-345-6671
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist