Provider Demographics
NPI:1184834665
Name:CONSTANTINE L. POLITIS, D.D.S., P.C.
Entity Type:Organization
Organization Name:CONSTANTINE L. POLITIS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-386-8600
Mailing Address - Street 1:965 LAKE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1292
Mailing Address - Country:US
Mailing Address - Phone:708-386-8600
Mailing Address - Fax:708-386-8688
Practice Address - Street 1:965 LAKE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1292
Practice Address - Country:US
Practice Address - Phone:708-386-8600
Practice Address - Fax:708-386-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty