Provider Demographics
NPI:1962822296
Name:SOUTH HOLLAND DENTAL PC
Entity Type:Organization
Organization Name:SOUTH HOLLAND DENTAL PC
Other - Org Name:METRO SMILES - DOLTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSALIAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-499-0100
Mailing Address - Street 1:4842 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2531
Mailing Address - Country:US
Mailing Address - Phone:708-222-8302
Mailing Address - Fax:
Practice Address - Street 1:808 E SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2130
Practice Address - Country:US
Practice Address - Phone:708-499-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROSMILES - CICERO DENTAL, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-25
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty