Provider Demographics
NPI:1376554386
Name:GAVRILOS, JAMES T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:GAVRILOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4330
Mailing Address - Country:US
Mailing Address - Phone:847-381-4040
Mailing Address - Fax:847-381-4057
Practice Address - Street 1:129 PARK AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4330
Practice Address - Country:US
Practice Address - Phone:847-381-4040
Practice Address - Fax:847-381-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice