Provider Demographics
NPI:1477606234
Name:CONTOS, PETER A (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:CONTOS
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 1:1120 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3938
Mailing Address - Country:US
Mailing Address - Phone:847-804-9429
Mailing Address - Fax:773-262-9850
Practice Address - Street 1:6428 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5209
Practice Address - Country:US
Practice Address - Phone:773-973-0531
Practice Address - Fax:773-262-9850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66391223G0001X
IL0190267501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9179859Medicaid