Provider Demographics
NPI:1821200379
Name:GEORGIOPOULOS, NICKOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:
Last Name:GEORGIOPOULOS
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 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:773-525-4632
Practice Address - Street 1:2740 W FOSTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3524
Practice Address - Country:US
Practice Address - Phone:773-561-3368
Practice Address - Fax:773-293-8968
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist