Provider Demographics
NPI:1710132824
Name:SARANTOPOULOS, DEMETRIOS MICHAEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:DEMETRIOS
Middle Name:MICHAEL
Last Name:SARANTOPOULOS
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 1:3722 S. HARLEM AVE.
Mailing Address - Street 2:STE 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-442-5657
Mailing Address - Fax:
Practice Address - Street 1:845 N. MICHIGAN AVE
Practice Address - Street 2:STE. 920-W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-944-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist