Provider Demographics
NPI:1427275973
Name:LALLAS, MARK ARISTEDES (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ARISTEDES
Last Name:LALLAS
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 1:120 W EASTMAN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5937
Mailing Address - Country:US
Mailing Address - Phone:847-253-7477
Mailing Address - Fax:847-253-7479
Practice Address - Street 1:120 W EASTMAN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5937
Practice Address - Country:US
Practice Address - Phone:847-253-7477
Practice Address - Fax:847-253-7479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0222911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice