Provider Demographics
NPI:1982736559
Name:KOTSAKIS, GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KOTSAKIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 N. BARRINGTON RD.,
Mailing Address - Street 2:#506
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5020
Mailing Address - Country:US
Mailing Address - Phone:847-884-7080
Mailing Address - Fax:847-884-8894
Practice Address - Street 1:1585 N. BARRINGTON RD.,
Practice Address - Street 2:#506
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5020
Practice Address - Country:US
Practice Address - Phone:847-884-7080
Practice Address - Fax:847-884-8894
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL772591Medicare ID - Type Unspecified
ILT38847Medicare UPIN