Provider Demographics
NPI:1992865927
Name:MANOS-BALIS, DEBBIE G (DDS)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:G
Last Name:MANOS-BALIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 EUCLID AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-2083
Mailing Address - Country:US
Mailing Address - Phone:847-312-6116
Mailing Address - Fax:847-253-8531
Practice Address - Street 1:4200 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2083
Practice Address - Country:US
Practice Address - Phone:847-253-8505
Practice Address - Fax:847-253-8531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190225521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice