Provider Demographics
NPI:1710018205
Name:SPYRATOS, SPIRIDON A (D D S, PC)
Entity Type:Individual
Prefix:DR
First Name:SPIRIDON
Middle Name:A
Last Name:SPYRATOS
Suffix:
Gender:M
Credentials:D D S, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-4622
Mailing Address - Country:US
Mailing Address - Phone:815-609-1110
Mailing Address - Fax:815-609-0575
Practice Address - Street 1:2111 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-4622
Practice Address - Country:US
Practice Address - Phone:815-609-1110
Practice Address - Fax:815-609-0575
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist