Provider Demographics
NPI:1225402795
Name:DGBDDS LLC, DENISE MANIAKOURAS, DDS
Entity Type:Organization
Organization Name:DGBDDS LLC, DENISE MANIAKOURAS, DDS
Other - Org Name:BITE SIZE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANIAKOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-789-9289
Mailing Address - Street 1:39 E COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1385
Mailing Address - Country:US
Mailing Address - Phone:708-789-9289
Mailing Address - Fax:708-789-9285
Practice Address - Street 1:39 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1385
Practice Address - Country:US
Practice Address - Phone:708-789-9289
Practice Address - Fax:708-789-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210025341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty