Provider Demographics
NPI:1932234069
Name:KOGIONIS, JAMES N (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:KOGIONIS
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 1:7751 159TH ST
Mailing Address - Street 2:# 7
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-9304
Mailing Address - Country:US
Mailing Address - Phone:708-532-4705
Mailing Address - Fax:
Practice Address - Street 1:7751 159TH ST
Practice Address - Street 2:# 7
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-9304
Practice Address - Country:US
Practice Address - Phone:708-532-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice