Provider Demographics
NPI:1801945142
Name:KOTSIOPOULOS, PETER J (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:KOTSIOPOULOS
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 1:135 W JOHNSON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6182
Mailing Address - Country:US
Mailing Address - Phone:847-776-1202
Mailing Address - Fax:847-776-1211
Practice Address - Street 1:135 W JOHNSON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6182
Practice Address - Country:US
Practice Address - Phone:847-776-1202
Practice Address - Fax:847-776-1211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice