Provider Demographics
NPI:1083284160
Name:TSOTSIS, POLYMNIA VASILIKI (DMD)
Entity Type:Individual
Prefix:
First Name:POLYMNIA
Middle Name:VASILIKI
Last Name:TSOTSIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 BENNETT DR APT 406
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4735
Mailing Address - Country:US
Mailing Address - Phone:415-966-7761
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE BLDG 273
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4700
Practice Address - Country:US
Practice Address - Phone:415-966-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1360002641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics