Provider Demographics
NPI:1225200140
Name:CICERO DENTAL INC
Entity Type:Organization
Organization Name:CICERO DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSALIAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-923-1841
Mailing Address - Street 1:7110 W 127TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1571
Mailing Address - Country:US
Mailing Address - Phone:708-923-1841
Mailing Address - Fax:708-923-7025
Practice Address - Street 1:7110 W 127TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1571
Practice Address - Country:US
Practice Address - Phone:708-923-1841
Practice Address - Fax:708-923-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty