Provider Demographics
NPI:1073735718
Name:DEAN J. KOKINIAS D.D.S., P.C.
Entity Type:Organization
Organization Name:DEAN J. KOKINIAS D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKINIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-398-5550
Mailing Address - Street 1:6085 STRATHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6635
Mailing Address - Country:US
Mailing Address - Phone:815-398-5550
Mailing Address - Fax:815-398-5920
Practice Address - Street 1:6085 STRATHMOOR DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6635
Practice Address - Country:US
Practice Address - Phone:815-398-5550
Practice Address - Fax:815-398-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL221281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty