Provider Demographics
NPI:1164687588
Name:ELAINE G. STOLIS,D.D.S. & ASSOCIATES
Entity Type:Organization
Organization Name:ELAINE G. STOLIS,D.D.S. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:STOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-974-9550
Mailing Address - Street 1:8114 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2206
Mailing Address - Country:US
Mailing Address - Phone:708-974-9550
Mailing Address - Fax:
Practice Address - Street 1:8114 W 111TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2206
Practice Address - Country:US
Practice Address - Phone:708-974-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190181551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty