Provider Demographics
NPI:1316046279
Name:CONTOS, PAUL DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:CONTOS
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 1:1900 HOLLISTER DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5253
Mailing Address - Country:US
Mailing Address - Phone:847-367-5252
Mailing Address - Fax:847-367-5257
Practice Address - Street 1:1900 HOLLISTER DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5253
Practice Address - Country:US
Practice Address - Phone:847-367-5252
Practice Address - Fax:847-367-5257
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A155811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice