Provider Demographics
NPI:1134274657
Name:IFANTIS, JOHN G (DDS, PC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:IFANTIS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9251 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2102
Mailing Address - Country:US
Mailing Address - Phone:847-663-0003
Mailing Address - Fax:847-663-0390
Practice Address - Street 1:9251 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2102
Practice Address - Country:US
Practice Address - Phone:847-663-0003
Practice Address - Fax:847-663-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice