Provider Demographics
NPI:1205238953
Name:DANOS, GEORGE PANTELIS
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PANTELIS
Last Name:DANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6073
Mailing Address - Country:US
Mailing Address - Phone:708-424-2277
Mailing Address - Fax:708-424-6611
Practice Address - Street 1:5101 W 111TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6073
Practice Address - Country:US
Practice Address - Phone:708-424-2277
Practice Address - Fax:708-424-6611
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD19017908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist