Provider Demographics
NPI:1437226669
Name:ECONOMOS, JAMES PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PETER
Last Name:ECONOMOS
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 1:106 W BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7880
Mailing Address - Country:US
Mailing Address - Phone:630-830-4930
Mailing Address - Fax:630-830-4953
Practice Address - Street 1:106 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-7880
Practice Address - Country:US
Practice Address - Phone:630-830-4930
Practice Address - Fax:630-830-4953
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19016838IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice