Provider Demographics
NPI:1164859161
Name:PANOS, VASILIOS S (DDS)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:S
Last Name:PANOS
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 1:2208 MIDWEST RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1277
Mailing Address - Country:US
Mailing Address - Phone:630-954-4747
Mailing Address - Fax:
Practice Address - Street 1:2208 MIDWEST RD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1277
Practice Address - Country:US
Practice Address - Phone:630-954-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-022204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist