Provider Demographics
NPI:1376981522
Name:POLITAKIS, GEORGE PETE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PETE
Last Name:POLITAKIS
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 1:17725 INDIANA CT
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9375
Mailing Address - Country:US
Mailing Address - Phone:219-313-1275
Mailing Address - Fax:
Practice Address - Street 1:2505 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6994
Practice Address - Country:US
Practice Address - Phone:219-548-2400
Practice Address - Fax:219-548-2499
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011986A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice