Provider Demographics
NPI:1194194639
Name:JOHN KATSIS D.D.S., LTD.
Entity Type:Organization
Organization Name:JOHN KATSIS D.D.S., LTD.
Other - Org Name:JOHN KATSIS JR. D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHODONTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:630-894-5557
Mailing Address - Street 1:110 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-6621
Mailing Address - Country:US
Mailing Address - Phone:630-894-5557
Mailing Address - Fax:
Practice Address - Street 1:110 S OAK AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-6621
Practice Address - Country:US
Practice Address - Phone:630-894-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190160971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty