Provider Demographics
NPI:1275797474
Name:MAGGOS, EVELYN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:T
Last Name:MAGGOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W276 GENEVA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2228
Mailing Address - Country:US
Mailing Address - Phone:630-510-7800
Mailing Address - Fax:
Practice Address - Street 1:26W276 GENEVA RD
Practice Address - Street 2:SUITE E
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2228
Practice Address - Country:US
Practice Address - Phone:630-510-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist