Provider Demographics
NPI:1659538445
Name:SAMPALIS, ANDREW JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:SAMPALIS
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 1:4560 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4869
Mailing Address - Country:US
Mailing Address - Phone:708-423-5155
Mailing Address - Fax:708-423-0719
Practice Address - Street 1:4560 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4869
Practice Address - Country:US
Practice Address - Phone:708-423-5155
Practice Address - Fax:708-423-0719
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190146711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice