Provider Demographics
NPI:1740308006
Name:CHICAGO ALL CARE DENTAL GROUP, LTD.
Entity type:Organization
Organization Name:CHICAGO ALL CARE DENTAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:PANOMITROS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-733-3343
Mailing Address - Street 1:PO BOX 08404
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-0404
Mailing Address - Country:US
Mailing Address - Phone:312-733-3343
Mailing Address - Fax:312-243-9868
Practice Address - Street 1:1918 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3015
Practice Address - Country:US
Practice Address - Phone:312-733-3343
Practice Address - Fax:312-243-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicare ID - Type UnspecifiedDENTIST