Provider Demographics
NPI:1326661778
Name:PDASPC
Entity Type:Organization
Organization Name:PDASPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:KARKAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-491-0660
Mailing Address - Street 1:1029 HOWARD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3877
Mailing Address - Country:US
Mailing Address - Phone:847-491-0660
Mailing Address - Fax:847-869-5858
Practice Address - Street 1:1029 HOWARD ST STE 201
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3877
Practice Address - Country:US
Practice Address - Phone:847-491-0660
Practice Address - Fax:847-869-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty