Provider Demographics
NPI:1609085604
Name:ATHANS, TONY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:T
Last Name:ATHANS
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 1:1707 SHERMER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5316
Mailing Address - Country:US
Mailing Address - Phone:847-498-3333
Mailing Address - Fax:847-498-3339
Practice Address - Street 1:1707 SHERMER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5316
Practice Address - Country:US
Practice Address - Phone:847-498-3333
Practice Address - Fax:847-498-3339
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice